const pptxgen = require("pptxgenjs");

// Fetch images helper
const { execSync } = require("child_process");

function fetchImages(urls) {
  try {
    const result = execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`,
      { timeout: 60000 }
    ).toString();
    return JSON.parse(result);
  } catch (e) {
    return urls.map(u => ({ url: u, base64: null, error: e.message }));
  }
}

// ---- Color Palette ----
const C = {
  navy:    "0D2B5E",  // dominant dark blue
  teal:    "1A7A8A",  // supporting teal
  amber:   "E5912A",  // accent
  white:   "FFFFFF",
  offwhite:"F4F7FB",
  ltgray:  "D8E4F0",
  text:    "1A2B3C",
  muted:   "5A6E82",
};

let pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3 x 7.5
pres.title = "Brachial Plexus Palsy & Physiotherapy Management";
pres.author = "Medical Education";
pres.subject = "Physiotherapy";

// =====================================================================
// SLIDE 1 — TITLE SLIDE
// =====================================================================
{
  let sl = pres.addSlide();
  // Full dark background
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.navy} });
  // Teal accent bar left
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.35, h:"100%", fill:{color:C.teal} });
  // Amber accent line
  sl.addShape(pres.ShapeType.rect, { x:0.35, y:3.2, w:9.5, h:0.06, fill:{color:C.amber} });

  sl.addText("BRACHIAL PLEXUS PALSY", {
    x:0.6, y:1.2, w:10, h:1.1,
    fontSize:42, bold:true, color:C.white, fontFace:"Calibri",
    charSpacing:3
  });
  sl.addText("& Physiotherapy Management", {
    x:0.6, y:2.35, w:10, h:0.7,
    fontSize:26, bold:false, color:C.ltgray, fontFace:"Calibri", italic:true
  });
  sl.addText("A Comprehensive Clinical Overview", {
    x:0.6, y:3.5, w:9, h:0.55,
    fontSize:18, color:C.amber, fontFace:"Calibri"
  });
  sl.addText([
    {text:"Anatomy  •  Classification  •  Clinical Features", options:{breakLine:true}},
    {text:"Assessment  •  Physiotherapy Interventions  •  Prognosis"}
  ], {
    x:0.6, y:6.2, w:10, h:0.8,
    fontSize:13, color:C.ltgray, fontFace:"Calibri", align:"left"
  });
}

// =====================================================================
// SLIDE 2 — TABLE OF CONTENTS
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });

  sl.addText("OVERVIEW", { x:0.4, y:0.22, w:12, h:0.65, fontSize:28, bold:true, color:C.white, fontFace:"Calibri" });

  const items = [
    ["01", "Introduction & Epidemiology"],
    ["02", "Anatomy of the Brachial Plexus"],
    ["03", "Etiology & Classification"],
    ["04", "Clinical Features & Deformities"],
    ["05", "Diagnosis & Investigations"],
    ["06", "Physiotherapy Assessment"],
    ["07", "Physiotherapy Management – Overview"],
    ["08", "ROM & Stretching Exercises"],
    ["09", "Strengthening & Functional Training"],
    ["10", "Electrotherapy & Splinting"],
    ["11", "Special Techniques"],
    ["12", "Prognosis & Outcome Measures"],
  ];

  const colW = 5.8;
  items.forEach((item, i) => {
    const col = i < 6 ? 0 : 1;
    const row = i % 6;
    const x = col === 0 ? 0.5 : 6.8;
    const y = 1.35 + row * 0.85;

    sl.addShape(pres.ShapeType.rect, { x:x, y:y, w:0.52, h:0.5, fill:{color:C.teal}, line:{color:C.teal} });
    sl.addText(item[0], { x:x, y:y, w:0.52, h:0.5, fontSize:14, bold:true, color:C.white, align:"center", valign:"middle", fontFace:"Calibri" });
    sl.addText(item[1], { x:x+0.62, y:y+0.05, w:colW-0.7, h:0.45, fontSize:14, color:C.text, fontFace:"Calibri", valign:"middle" });
  });
}

// =====================================================================
// SLIDE 3 — INTRODUCTION
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("INTRODUCTION & EPIDEMIOLOGY", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  const points = [
    "Brachial plexus palsy (BPP) results from injury to the network of nerves (C5–T1) controlling shoulder, arm, and hand function.",
    "Incidence: ~2 per 1,000 live births (obstetric/neonatal form); traumatic form common in young adults from high-energy injury.",
    "Most common obstetric cause: shoulder dystocia; most common traumatic cause: motorcycle accidents with traction injuries.",
    "Neonatal BPP — spontaneous recovery in >90% cases; however residual deficits occur in 10–25%.",
    "Traumatic BPP — prognosis depends on level (preganglionic vs postganglionic), mechanism (avulsion vs stretch), and time to treatment.",
    "Physiotherapy is the cornerstone of conservative management across ALL stages.",
  ];

  points.forEach((pt, i) => {
    sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.3+i*0.9, w:0.45, h:0.45, fill:{color:C.teal} });
    sl.addText(`${i+1}`, { x:0.4, y:1.3+i*0.9, w:0.45, h:0.45, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addText(pt, { x:1.0, y:1.3+i*0.9, w:11.8, h:0.5, fontSize:13.5, color:C.text, fontFace:"Calibri", valign:"middle" });
  });
}

// =====================================================================
// SLIDE 4 — ANATOMY
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("ANATOMY OF THE BRACHIAL PLEXUS", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // Left column — text
  const rows = [
    ["Roots", "C5, C6, C7, C8, T1 — emerge between anterior & middle scalene muscles"],
    ["Trunks", "Superior (C5,C6) · Middle (C7) · Inferior (C8,T1)"],
    ["Divisions", "Each trunk splits into anterior & posterior division (6 total)"],
    ["Cords", "Lateral, Posterior, Medial — named by relation to axillary artery"],
    ["Terminal\nBranches", "Musculocutaneous, Axillary, Radial, Median, Ulnar nerves"],
    ["Key Branches", "Long thoracic (serratus ant.), Suprascapular, Dorsal scapular, Phrenic"],
  ];

  rows.forEach(([label, text], i) => {
    sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.25+i*0.9, w:1.5, h:0.65, fill:{color:C.teal} });
    sl.addText(label, { x:0.4, y:1.25+i*0.9, w:1.5, h:0.65, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addText(text, { x:2.05, y:1.3+i*0.9, w:6.8, h:0.6, fontSize:13, color:C.text, valign:"middle" });
  });

  // Image placeholder box right
  sl.addShape(pres.ShapeType.rect, { x:9.2, y:1.2, w:3.7, h:5.6, fill:{color:C.ltgray}, line:{color:C.teal, pt:2} });
  sl.addText("Brachial Plexus\nAnatomy Diagram\n(C5–T1)", { x:9.2, y:3.0, w:3.7, h:2.0, fontSize:13, color:C.muted, align:"center", italic:true });

  // Footer note
  sl.addText("Mnemonic: 'Randy Travis Drinks Cold Beer' → Roots, Trunks, Divisions, Cords, Branches", {
    x:0.4, y:7.1, w:12, h:0.3, fontSize:11, color:C.teal, italic:true
  });
}

// =====================================================================
// SLIDE 5 — ETIOLOGY & CLASSIFICATION
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("ETIOLOGY & CLASSIFICATION", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // Etiology box
  sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.25, w:5.9, h:0.45, fill:{color:C.navy} });
  sl.addText("ETIOLOGY", { x:0.4, y:1.25, w:5.9, h:0.45, fontSize:15, bold:true, color:C.white, align:"center" });
  const etio = [
    "OBSTETRIC/NEONATAL: shoulder dystocia, forceps delivery, large neonate, breech position, prolonged labor",
    "TRAUMATIC: motorcycle accidents (traction), falls, high-energy sports, penetrating wounds, iatrogenic",
    "OTHER: tumors (Pancoast), radiation neuropathy, thoracic outlet syndrome, neuralgic amyotrophy",
  ];
  etio.forEach((e, i) => {
    sl.addShape(pres.ShapeType.roundRect, { x:0.4, y:1.8+i*0.88, w:5.9, h:0.72, fill:{color:C.ltgray}, line:{color:C.teal, pt:1}, rectRadius:0.05 });
    sl.addText(e, { x:0.55, y:1.85+i*0.88, w:5.65, h:0.6, fontSize:12, color:C.text, valign:"middle" });
  });

  // Classification box
  sl.addShape(pres.ShapeType.rect, { x:6.9, y:1.25, w:6.0, h:0.45, fill:{color:C.navy} });
  sl.addText("CLASSIFICATION", { x:6.9, y:1.25, w:6.0, h:0.45, fontSize:15, bold:true, color:C.white, align:"center" });

  const classes = [
    ["Erb's Palsy\n(Upper)", "C5, C6 (±C7)", "Waiter's Tip", "Best — >90% recover"],
    ["Klumpke's Palsy\n(Lower)", "C8, T1", "Claw hand + Horner", "Poor — rarely full recovery"],
    ["Total Plexus\nPalsy", "C5–T1", "Flail limb", "Worst prognosis"],
  ];

  sl.addShape(pres.ShapeType.rect, { x:6.9, y:1.75, w:1.5, h:0.38, fill:{color:C.teal} });
  sl.addText("Type", { x:6.9, y:1.75, w:1.5, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });
  sl.addShape(pres.ShapeType.rect, { x:8.42, y:1.75, w:1.4, h:0.38, fill:{color:C.teal} });
  sl.addText("Roots", { x:8.42, y:1.75, w:1.4, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });
  sl.addShape(pres.ShapeType.rect, { x:9.84, y:1.75, w:1.55, h:0.38, fill:{color:C.teal} });
  sl.addText("Deformity", { x:9.84, y:1.75, w:1.55, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });
  sl.addShape(pres.ShapeType.rect, { x:11.41, y:1.75, w:1.47, h:0.38, fill:{color:C.teal} });
  sl.addText("Prognosis", { x:11.41, y:1.75, w:1.47, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });

  classes.forEach((row, i) => {
    const bg = i%2===0 ? C.white : C.ltgray;
    sl.addShape(pres.ShapeType.rect, { x:6.9, y:2.18+i*0.9, w:6.0, h:0.8, fill:{color:bg} });
    sl.addText(row[0], { x:6.92, y:2.2+i*0.9, w:1.48, h:0.75, fontSize:11, bold:true, color:C.navy, valign:"middle", align:"center" });
    sl.addText(row[1], { x:8.42, y:2.2+i*0.9, w:1.4, h:0.75, fontSize:11, color:C.text, valign:"middle", align:"center" });
    sl.addText(row[2], { x:9.84, y:2.2+i*0.9, w:1.55, h:0.75, fontSize:11, color:C.text, valign:"middle", align:"center" });
    sl.addText(row[3], { x:11.41, y:2.2+i*0.9, w:1.47, h:0.75, fontSize:11, color:C.navy, bold:true, valign:"middle", align:"center" });
  });

  // Nerve injury classification
  sl.addShape(pres.ShapeType.rect, { x:6.9, y:5.1, w:6.0, h:0.4, fill:{color:C.navy} });
  sl.addText("SEDDON / SUNDERLAND NERVE INJURY CLASSIFICATION", { x:6.9, y:5.1, w:6.0, h:0.4, fontSize:11, bold:true, color:C.white, align:"center" });

  const seddon = [
    ["Neurapraxia / I", "Demyelination only", "Full recovery 2–12 wks"],
    ["Axonotmesis / II", "Axon disrupted", "Weeks–months recovery"],
    ["Sunderland III", "Endoneurium injured", "Incomplete recovery"],
    ["Sunderland IV", "Perineurium injured", "Neuroma-in-continuity"],
    ["Neurotmesis / V", "Nerve severed", "Surgery required"],
  ];
  seddon.forEach((row, i) => {
    const bg = i%2===0 ? C.offwhite : C.ltgray;
    sl.addShape(pres.ShapeType.rect, { x:6.9, y:5.52+i*0.38, w:6.0, h:0.36, fill:{color:bg} });
    sl.addText(row[0], { x:6.92, y:5.54+i*0.38, w:2.0, h:0.33, fontSize:10.5, bold:true, color:C.navy, valign:"middle" });
    sl.addText(row[1], { x:8.95, y:5.54+i*0.38, w:1.9, h:0.33, fontSize:10.5, color:C.text, valign:"middle" });
    sl.addText(row[2], { x:10.88, y:5.54+i*0.38, w:2.0, h:0.33, fontSize:10.5, color:C.muted, valign:"middle" });
  });

  // Note about preganglionic vs postganglionic
  sl.addText("Preganglionic (root avulsion): worst prognosis; Postganglionic (distal to DRG): better surgical outcomes", {
    x:0.4, y:5.4, w:5.9, h:0.5, fontSize:11, color:C.teal, italic:true, valign:"middle"
  });
}

// =====================================================================
// SLIDE 6 — CLINICAL FEATURES
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("CLINICAL FEATURES & DEFORMITIES", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  const cards = [
    {
      title:"Erb's Palsy (C5–C6)",
      color: C.teal,
      pts:[
        "Waiter's Tip deformity",
        "Shoulder: adducted, internally rotated",
        "Elbow: extended, pronated",
        "Wrist: flexed",
        "Absent deltoid, biceps, brachioradialis",
        "Biceps reflex absent",
        "Moro reflex asymmetric",
      ]
    },
    {
      title:"Klumpke's Palsy (C8–T1)",
      color:"8B3A8B",
      pts:[
        "Claw hand deformity",
        "Intrinsic hand muscle paralysis",
        "Horner syndrome: ptosis, miosis, anhidrosis",
        "Wrist & finger extensors affected",
        "Grasp reflex absent",
        "Sensory loss medial arm & forearm",
      ]
    },
    {
      title:"Total Plexus (C5–T1)",
      color:"B22222",
      pts:[
        "Complete flaccid paralysis — entire UL",
        "All reflexes absent in affected limb",
        "Global sensory loss",
        "Elevated hemidiaphragm (phrenic n.)",
        "Winged scapula (long thoracic n.)",
        "Worst prognosis; often surgical",
      ]
    },
  ];

  cards.forEach((card, i) => {
    const x = 0.4 + i * 4.3;
    sl.addShape(pres.ShapeType.rect, { x:x, y:1.25, w:4.1, h:0.5, fill:{color:card.color} });
    sl.addText(card.title, { x:x, y:1.25, w:4.1, h:0.5, fontSize:13.5, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addShape(pres.ShapeType.rect, { x:x, y:1.78, w:4.1, h:5.35, fill:{color:C.white}, line:{color:card.color, pt:1.5} });
    card.pts.forEach((pt, j) => {
      sl.addText([{text:"• ", options:{color:card.color, bold:true}}, {text:pt, options:{color:C.text}}], {
        x:x+0.15, y:1.9+j*0.72, w:3.8, h:0.6, fontSize:12.5, valign:"middle"
      });
    });
  });
}

// =====================================================================
// SLIDE 7 — DIAGNOSIS & INVESTIGATIONS
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("DIAGNOSIS & INVESTIGATIONS", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  const sections = [
    {
      title:"CLINICAL ASSESSMENT",
      x:0.4, y:1.25, w:4.0,
      pts:[
        "Comprehensive motor & sensory evaluation",
        "Active Movement Scale (AMS) in neonates",
        "Mallet classification (>2 years)",
        "Tinel sign — advancing = nerve recovery",
        "Horner sign (sympathetic chain)",
        "Winged scapula (serratus anterior)",
        "Weak rhomboids (dorsal scapular n.)",
      ]
    },
    {
      title:"ELECTRODIAGNOSTICS",
      x:4.7, y:1.25, w:4.2,
      pts:[
        "EMG: fibrillation potentials = denervation; done 4–6 wks post-injury",
        "NCS: assesses extent of injury & monitors recovery",
        "SNAPs: normal + sensory loss = preganglionic injury",
        "Somatosensory evoked potentials (SSEP): nerve root continuity",
        "Paraspinal EMG: abnormal = avulsion",
      ]
    },
    {
      title:"IMAGING",
      x:9.1, y:1.25, w:4.0,
      pts:[
        "X-ray: cervical spine, chest (hemidiaphragm), shoulder girdle",
        "CT myelography: GOLD STANDARD for root avulsions (pseudomeningocele)",
        "MRI: peripheral neuroma, cord signal change, soft tissue",
        "MR Neurography: detailed nerve mapping",
        "USS: dynamic assessment in infants",
      ]
    },
  ];

  sections.forEach(sec => {
    sl.addShape(pres.ShapeType.rect, { x:sec.x, y:sec.y, w:sec.w, h:0.48, fill:{color:C.teal} });
    sl.addText(sec.title, { x:sec.x, y:sec.y, w:sec.w, h:0.48, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addShape(pres.ShapeType.rect, { x:sec.x, y:sec.y+0.5, w:sec.w, h:5.5, fill:{color:C.white}, line:{color:C.teal, pt:1} });
    sec.pts.forEach((pt, j) => {
      sl.addText([{text:"▸ ", options:{color:C.teal, bold:true}}, {text:pt, options:{color:C.text}}], {
        x:sec.x+0.15, y:sec.y+0.65+j*0.78, w:sec.w-0.2, h:0.68, fontSize:12, valign:"middle"
      });
    });
  });

  sl.addText("Poor Prognostic Signs: Horner syndrome • No biceps return by 3–6 months • Preganglionic avulsion • Paraspinal EMG changes", {
    x:0.4, y:7.05, w:12.5, h:0.35, fontSize:11.5, color:"B22222", bold:true, italic:true
  });
}

// =====================================================================
// SLIDE 8 — PHYSIOTHERAPY ASSESSMENT
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("PHYSIOTHERAPY ASSESSMENT", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  const cols = [
    {
      title:"SUBJECTIVE HISTORY",
      x:0.4,
      pts:[
        "Mechanism of injury & date",
        "Birth history (neonatal BPP)",
        "Pain: nature, severity, distribution",
        "Functional limitations in ADL",
        "Prior treatments / surgeries",
        "Patient/parent goals",
      ]
    },
    {
      title:"OBJECTIVE ASSESSMENT",
      x:4.8,
      pts:[
        "Posture & attitude of the affected limb",
        "Inspection: wasting, deformity, scars",
        "PROM & AROM — all UL joints (goniometer)",
        "Muscle power — MRC grading (0–5)",
        "Reflexes: biceps, triceps, brachioradialis",
        "Sensory: light touch, pin-prick, 2-pt discrimination",
      ]
    },
    {
      title:"OUTCOME MEASURES",
      x:9.2,
      pts:[
        "Active Movement Scale (AMS) — neonates",
        "Mallet Classification — shoulder function (>2yr)",
        "Disabilities of Arm, Shoulder, Hand (DASH)",
        "Medical Research Council (MRC) scale",
        "Fugl-Meyer Assessment",
        "Pediatric: PMAL, AHA (Assisting Hand Assessment)",
      ]
    },
  ];

  cols.forEach(col => {
    sl.addShape(pres.ShapeType.rect, { x:col.x, y:1.25, w:4.1, h:0.48, fill:{color:C.navy} });
    sl.addText(col.title, { x:col.x, y:1.25, w:4.1, h:0.48, fontSize:13, bold:true, color:C.white, align:"center" });
    col.pts.forEach((pt, j) => {
      const bg = j%2===0 ? C.white : C.ltgray;
      sl.addShape(pres.ShapeType.rect, { x:col.x, y:1.78+j*0.85, w:4.1, h:0.78, fill:{color:bg}, line:{color:C.ltgray, pt:0.5} });
      sl.addText([{text:"• ", options:{color:C.teal, bold:true}}, {text:pt, options:{color:C.text}}], {
        x:col.x+0.12, y:1.85+j*0.85, w:3.9, h:0.65, fontSize:12.5, valign:"middle"
      });
    });
  });

  sl.addText("Re-assess every 4–6 weeks; document with standardised outcome measures to track recovery and guide progression.", {
    x:0.4, y:7.1, w:12.5, h:0.3, fontSize:11, color:C.teal, italic:true
  });
}

// =====================================================================
// SLIDE 9 — PHYSIOTHERAPY MANAGEMENT OVERVIEW
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("PHYSIOTHERAPY MANAGEMENT — OVERVIEW", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // Phase timeline
  const phases = [
    { label:"PHASE 1\nAcute / Early\n(0–3 months)", color:C.teal, goals:"Pain control\nOedema management\nPROM maintenance\nFamily education\nSplinting" },
    { label:"PHASE 2\nSubacute\n(3–6 months)", color:"2E7D52", goals:"Muscle re-education\nActive-assisted ROM\nStrengthening begins\nNMES / FES\nADL training" },
    { label:"PHASE 3\nRecovery\n(6–12 months)", color:"5B4A8A", goals:"Progressive strengthening\nFunctional training\nBimanual activities\nPropioceptive exercises\nReturn to activity" },
    { label:"PHASE 4\nChronic /\nPost-surgical", color:"8B3A2E", goals:"Post-op rehabilitation\nTendon/nerve transfer retraining\nMaximising function\nCompensatory strategies\nLong-term maintenance" },
  ];

  phases.forEach((ph, i) => {
    const x = 0.35 + i * 3.18;
    // Arrow connector
    if (i < 3) {
      sl.addShape(pres.ShapeType.rect, { x:x+2.9, y:2.32, w:0.28, h:0.38, fill:{color:C.amber} });
    }
    sl.addShape(pres.ShapeType.rect, { x:x, y:1.25, w:2.9, h:0.9, fill:{color:ph.color} });
    sl.addText(ph.label, { x:x, y:1.25, w:2.9, h:0.9, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addShape(pres.ShapeType.rect, { x:x, y:2.2, w:2.9, h:4.7, fill:{color:C.white}, line:{color:ph.color, pt:1.5} });
    sl.addText(ph.goals, { x:x+0.1, y:2.3, w:2.75, h:4.5, fontSize:12.5, color:C.text, valign:"top", align:"left", paraSpaceAfter:6 });
  });

  sl.addShape(pres.ShapeType.rect, { x:0.35, y:7.1, w:12.6, h:0.3, fill:{color:C.ltgray} });
  sl.addText("Goals: Prevent contractures • Facilitate nerve recovery • Maximise function • Promote independence • Education", {
    x:0.5, y:7.1, w:12.4, h:0.3, fontSize:11, color:C.navy, bold:true, align:"center"
  });
}

// =====================================================================
// SLIDE 10 — ROM & STRETCHING
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("ROM EXERCISES & STRETCHING", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // PROM column
  sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.25, w:5.9, h:0.48, fill:{color:C.teal} });
  sl.addText("PASSIVE ROM (PROM)", { x:0.4, y:1.25, w:5.9, h:0.48, fontSize:14, bold:true, color:C.white, align:"center" });
  const promPts = [
    "START immediately from day 1 to prevent contractures",
    "Shoulder: flexion, abduction, external rotation, horizontal abduction",
    "Elbow: flexion–extension, supination–pronation",
    "Wrist & fingers: full ROM in all planes",
    "Frequency: 3–4× daily; 10–15 repetitions each direction",
    "Precautions: gentle — avoid aggressive stretching in acute phase; risk of shoulder subluxation",
    "Parent-taught PROM is KEY in neonatal BPP — daily home program",
  ];
  promPts.forEach((pt, i) => {
    sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.78+i*0.78, w:5.9, h:0.7, fill:{i%2===0?C.white:C.ltgray} });
    sl.addText([{text:"▸ ", options:{color:C.teal, bold:true}}, {text:pt, options:{color:C.text}}], {
      x:0.5, y:1.82+i*0.78, w:5.7, h:0.62, fontSize:12, valign:"middle"
    });
  });

  // AROM / Stretching column
  sl.addShape(pres.ShapeType.rect, { x:6.9, y:1.25, w:6.1, h:0.48, fill:{color:"2E7D52"} });
  sl.addText("ACTIVE ROM & STRETCHING", { x:6.9, y:1.25, w:6.1, h:0.48, fontSize:14, bold:true, color:C.white, align:"center" });
  const aromPts = [
    "Initiate AROM as soon as voluntary muscle activity returns (MRC ≥2)",
    "Active-assisted ROM: gravity eliminated positions initially",
    "Pendulum exercises: shoulder — gentle distraction",
    "Codman's exercises: pendular swinging for shoulder mobility",
    "Stretching for internal rotation contracture: key prevention goal",
    "Subscapularis/pectoral stretch to prevent glenoid hypoplasia",
    "Nerve gliding / neurodynamic mobilisation: median, ulnar, radial nerve",
  ];
  aromPts.forEach((pt, i) => {
    sl.addShape(pres.ShapeType.rect, { x:6.9, y:1.78+i*0.78, w:6.1, h:0.7, fill:{i%2===0?C.white:C.ltgray} });
    sl.addText([{text:"▸ ", options:{color:"2E7D52", bold:true}}, {text:pt, options:{color:C.text}}], {
      x:7.0, y:1.82+i*0.78, w:5.9, h:0.62, fontSize:12, valign:"middle"
    });
  });

  sl.addText("Critical goal: prevent internal rotation contracture and glenoid dysplasia by maintaining PROM of shoulder ER from day 1", {
    x:0.4, y:7.1, w:12.5, h:0.3, fontSize:11, color:"B22222", bold:true, italic:true
  });
}

// =====================================================================
// SLIDE 11 — STRENGTHENING & FUNCTIONAL TRAINING
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("STRENGTHENING & FUNCTIONAL TRAINING", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // Strengthening
  sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.25, w:6.0, h:0.48, fill:{color:C.teal} });
  sl.addText("PROGRESSIVE STRENGTHENING", { x:0.4, y:1.25, w:6.0, h:0.48, fontSize:14, bold:true, color:C.white, align:"center" });

  const strPts = [
    ["Gravity Eliminated Phase", "Horizontal plane exercises; Theraband (very light); aquatic therapy"],
    ["Anti-Gravity Phase", "Isometric → isotonic; deltoid, biceps, external rotators, wrist extensors"],
    ["Resistance Phase", "Progressive resistance training; Theraband, dumbbells, machines"],
    ["Scapular Stabilisation", "Serratus anterior, rhomboids, trapezius strengthening — essential for glenohumeral stability"],
    ["Grip & Pinch Strength", "Hand putty, finger ladders, resistive hand exercises — critical for ADL"],
    ["Closed Chain Exercises", "Weight-bearing through hand, wall push-ups — proprioceptive & strength gains"],
  ];
  strPts.forEach((row, i) => {
    sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.78+i*0.83, w:2.3, h:0.72, fill:{color:C.navy} });
    sl.addText(row[0], { x:0.4, y:1.78+i*0.83, w:2.3, h:0.72, fontSize:11.5, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addShape(pres.ShapeType.rect, { x:2.72, y:1.78+i*0.83, w:3.68, h:0.72, fill:{i%2===0?C.white:C.ltgray}, line:{color:C.teal, pt:0.5} });
    sl.addText(row[1], { x:2.82, y:1.82+i*0.83, w:3.5, h:0.62, fontSize:12, color:C.text, valign:"middle" });
  });

  // Functional training
  sl.addShape(pres.ShapeType.rect, { x:7.0, y:1.25, w:6.0, h:0.48, fill:{color:"5B4A8A"} });
  sl.addText("FUNCTIONAL & ADL TRAINING", { x:7.0, y:1.25, w:6.0, h:0.48, fontSize:14, bold:true, color:C.white, align:"center" });

  const funcPts = [
    "Bimanual activities: encourage use of both hands in play/tasks",
    "CIMT — Constraint Induced Movement Therapy: restraint of unaffected hand to force use of affected limb (paediatric)",
    "Task-specific training: dressing, feeding, writing, tool use",
    "Mirror therapy: activates motor cortex, reduces learned non-use",
    "Virtual Reality (VR) rehabilitation: interactive games for ROM & coordination",
    "Hydrotherapy/Aquatic therapy: buoyancy-assisted strengthening",
    "Return-to-sport / work: sport-specific & occupational rehabilitation protocols",
    "Home exercise program (HEP): individualised, written, with photos/videos",
  ];
  funcPts.forEach((pt, i) => {
    sl.addText([{text:`${i+1}. `, options:{color:"5B4A8A", bold:true}}, {text:pt, options:{color:C.text}}], {
      x:7.1, y:1.8+i*0.7, w:5.8, h:0.62, fontSize:12, valign:"middle"
    });
  });

  sl.addText("Progression principle: Pain-free • Start distal to proximal • Gravity-eliminated → against gravity → with resistance", {
    x:0.4, y:7.1, w:12.5, h:0.3, fontSize:11, color:C.teal, bold:true, italic:true
  });
}

// =====================================================================
// SLIDE 12 — ELECTROTHERAPY & SPLINTING
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("ELECTROTHERAPY & SPLINTING / ORTHOTICS", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // Electrotherapy
  sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.25, w:6.0, h:0.48, fill:{color:C.teal} });
  sl.addText("ELECTROTHERAPY MODALITIES", { x:0.4, y:1.25, w:6.0, h:0.48, fontSize:14, bold:true, color:C.white, align:"center" });

  const electro = [
    {
      mod:"NMES / FES",
      desc:"Neuromuscular Electrical Stimulation / Functional Electrical Stimulation",
      detail:"Retard denervation atrophy • Facilitate muscle re-education • Enhance motor recovery • Frequency 16–35 Hz typical; pulsed mode",
      color:C.teal
    },
    {
      mod:"TENS",
      desc:"Transcutaneous Electrical Nerve Stimulation",
      detail:"Pain management in painful neuropathy / causalgia • Does NOT improve motor recovery directly",
      color:"2E7D52"
    },
    {
      mod:"Ultrasound",
      desc:"Therapeutic Ultrasound (1 MHz, 0.8 W/cm²)",
      detail:"Pulsed mode for tissue healing • Promotes axonal regeneration • Reduces scar/fibrosis around nerve",
      color:"5B4A8A"
    },
    {
      mod:"LASER",
      desc:"Low Level Laser Therapy (LLLT)",
      detail:"Promotes Schwann cell proliferation • Enhances nerve regeneration • Anti-inflammatory effects",
      color:"8B3A2E"
    },
    {
      mod:"IFT",
      desc:"Interferential Therapy",
      detail:"Pain relief, muscle stimulation, oedema reduction in subacute/chronic phase",
      color:"6B4A1A"
    },
  ];

  electro.forEach((e, i) => {
    sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.82+i*1.02, w:1.0, h:0.88, fill:{color:e.color} });
    sl.addText(e.mod, { x:0.4, y:1.82+i*1.02, w:1.0, h:0.88, fontSize:10.5, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addShape(pres.ShapeType.rect, { x:1.42, y:1.82+i*1.02, w:4.98, h:0.88, fill:{i%2===0?C.white:C.ltgray} });
    sl.addText([
      {text:e.desc+"\n", options:{bold:true, color:e.color, fontSize:11}},
      {text:e.detail, options:{color:C.text, fontSize:11}}
    ], { x:1.52, y:1.84+i*1.02, w:4.78, h:0.82, fontSize:11, valign:"middle" });
  });

  // Splinting / Orthotics
  sl.addShape(pres.ShapeType.rect, { x:7.0, y:1.25, w:6.0, h:0.48, fill:{color:"5B4A8A"} });
  sl.addText("SPLINTING & ORTHOTICS", { x:7.0, y:1.25, w:6.0, h:0.48, fontSize:14, bold:true, color:C.white, align:"center" });

  const splints = [
    {
      type:"Shoulder Abduction Splint",
      purpose:"Positions shoulder in abduction & ER; prevents adduction contracture; used in neonatal Erb's palsy",
    },
    {
      type:"Wrist-Hand Orthosis (WHO)",
      purpose:"Maintains wrist in functional extension; prevents wrist drop (radial involvement) and metacarpal subluxation",
    },
    {
      type:"Resting Hand Splint",
      purpose:"Worn at night; maintains hand in functional position; prevents intrinsic-minus deformity in Klumpke's",
    },
    {
      type:"Dynamic Splinting",
      purpose:"Allows active motion while providing resistance; improves ROM in contractures; serial casting is alternative",
    },
    {
      type:"Sling Support",
      purpose:"Supports flail limb weight; prevents shoulder subluxation/dislocation in early flaccid phase",
    },
    {
      type:"Kinesio Taping",
      purpose:"Scapular stabilisation tape; enhances proprioception; improves shoulder ER and flexion (2023 RCT evidence)",
    },
  ];

  splints.forEach((sp, i) => {
    sl.addShape(pres.ShapeType.rect, { x:7.0, y:1.82+i*0.92, w:2.0, h:0.78, fill:{color:"5B4A8A"} });
    sl.addText(sp.type, { x:7.0, y:1.82+i*0.92, w:2.0, h:0.78, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });
    sl.addShape(pres.ShapeType.rect, { x:9.02, y:1.82+i*0.92, w:3.98, h:0.78, fill:{i%2===0?C.white:C.ltgray} });
    sl.addText(sp.purpose, { x:9.12, y:1.86+i*0.92, w:3.78, h:0.68, fontSize:11.5, color:C.text, valign:"middle" });
  });
}

// =====================================================================
// SLIDE 13 — SPECIAL TECHNIQUES
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("SPECIAL PHYSIOTHERAPY TECHNIQUES", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  const techniques = [
    {
      title:"Proprioceptive Neuromuscular\nFacilitation (PNF)",
      icon:"PNF",
      color:C.teal,
      pts:[
        "Diagonal patterns (D1/D2 flexion & extension) to facilitate weak muscles",
        "Techniques: Hold-Relax, Contract-Relax, Slow Reversal",
        "Promotes motor learning and neuromuscular re-education",
      ]
    },
    {
      title:"Neural Mobilisation /\nNeurodynamics",
      icon:"NM",
      color:"2E7D52",
      pts:[
        "Upper Limb Neurodynamic Tests (ULNT 1–4) used diagnostically & therapeutically",
        "Nerve slider vs tensioner techniques",
        "Reduces mechanosensitivity; improves nerve mobility",
      ]
    },
    {
      title:"Hydrotherapy",
      icon:"HT",
      color:"5B4A8A",
      pts:[
        "Warm water (35–37°C): muscle relaxation, pain relief",
        "Buoyancy-assisted strengthening in gravity-eliminated plane",
        "Aquatic AROM, resistance exercises using paddles/buoyancy aids",
      ]
    },
    {
      title:"Biofeedback &\nElectromyographic Training",
      icon:"BF",
      color:C.amber,
      pts:[
        "EMG biofeedback: visual/auditory cues for muscle activation",
        "Trains weak muscles to recruit optimally",
        "Improves motor learning in re-innervated muscles",
      ]
    },
    {
      title:"Botulinum Toxin A +\nPhysiotherapy",
      icon:"BTX",
      color:"8B3A2E",
      pts:[
        "BTX-A injected into spastic antagonists (biceps, subscapularis)",
        "Reduces co-contraction; creates therapeutic window for PT",
        "Combined with CIMT or strengthening for best outcomes",
      ]
    },
    {
      title:"Post-surgical\nRehabilitation",
      icon:"POST\nOP",
      color:"6B2A6A",
      pts:[
        "After nerve grafting: immobilisation → gentle PROM → active retraining as reinnervation occurs",
        "After tendon transfer: protected mobilisation per surgical protocol; re-education of transferred muscle new function",
        "Key principle: patience — nerve regeneration at ~1 mm/day",
      ]
    },
  ];

  techniques.forEach((tech, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.35 + col * 4.3;
    const y = 1.25 + row * 2.95;
    sl.addShape(pres.ShapeType.rect, { x:x, y:y, w:4.1, h:0.72, fill:{color:tech.color} });
    sl.addText([{text:tech.icon+" ", options:{bold:true, fontSize:14}},{text:tech.title, options:{fontSize:12.5}}], {
      x:x, y:y, w:4.1, h:0.72, color:C.white, bold:true, align:"center", valign:"middle"
    });
    sl.addShape(pres.ShapeType.rect, { x:x, y:y+0.74, w:4.1, h:2.12, fill:{color:C.white}, line:{color:tech.color, pt:1} });
    tech.pts.forEach((pt, j) => {
      sl.addText([{text:"• ", options:{bold:true, color:tech.color}},{text:pt, options:{color:C.text}}], {
        x:x+0.12, y:y+0.85+j*0.62, w:3.88, h:0.55, fontSize:11.5, valign:"middle"
      });
    });
  });
}

// =====================================================================
// SLIDE 14 — PROGNOSIS & OUTCOME
// =====================================================================
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:"100%", fill:{color:C.offwhite} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:0, w:"100%", h:1.05, fill:{color:C.navy} });
  sl.addShape(pres.ShapeType.rect, { x:0, y:1.05, w:"100%", h:0.06, fill:{color:C.amber} });
  sl.addText("PROGNOSIS & LONG-TERM OUTCOMES", { x:0.4, y:0.22, w:12, h:0.65, fontSize:26, bold:true, color:C.white });

  // Prognostic factors
  sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.25, w:6.0, h:0.45, fill:{color:C.teal} });
  sl.addText("PROGNOSTIC FACTORS", { x:0.4, y:1.25, w:6.0, h:0.45, fontSize:13.5, bold:true, color:C.white, align:"center" });

  const goodBad = [
    {factor:"Nerve injury type", good:"Neurapraxia / Axonotmesis", bad:"Neurotmesis / Avulsion"},
    {factor:"Timing of PT", good:"Early initiation (<3 months)", bad:"Delayed / no treatment"},
    {factor:"Age at injury", good:"Younger patients", bad:"Older patients"},
    {factor:"Level of injury", good:"Erb's (C5-C6)", bad:"Total plexus (C5-T1)"},
    {factor:"Biceps return", good:"By 2–3 months", bad:"Absent by 6 months"},
    {factor:"Horner sign", good:"Absent", bad:"Present (C8-T1 avulsion)"},
  ];
  sl.addShape(pres.ShapeType.rect, { x:0.4, y:1.72, w:2.3, h:0.38, fill:{color:C.navy} });
  sl.addText("Factor", { x:0.4, y:1.72, w:2.3, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });
  sl.addShape(pres.ShapeType.rect, { x:2.72, y:1.72, w:1.8, h:0.38, fill:{color:"2E7D52"} });
  sl.addText("Good Prognosis", { x:2.72, y:1.72, w:1.8, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });
  sl.addShape(pres.ShapeType.rect, { x:4.54, y:1.72, w:1.84, h:0.38, fill:{color:"B22222"} });
  sl.addText("Poor Prognosis", { x:4.54, y:1.72, w:1.84, h:0.38, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle" });

  goodBad.forEach((row, i) => {
    const bg = i%2===0?C.white:C.ltgray;
    sl.addShape(pres.ShapeType.rect, { x:0.4, y:2.13+i*0.76, w:6.0, h:0.68, fill:{color:bg} });
    sl.addText(row.factor, { x:0.45, y:2.16+i*0.76, w:2.22, h:0.6, fontSize:12, bold:true, color:C.navy, valign:"middle" });
    sl.addText(row.good, { x:2.73, y:2.16+i*0.76, w:1.78, h:0.6, fontSize:11.5, color:"2E7D52", valign:"middle", align:"center" });
    sl.addText(row.bad, { x:4.55, y:2.16+i*0.76, w:1.82, h:0.6, fontSize:11.5, color:"B22222", valign:"middle", align:"center" });
  });

  // Outcome stats
  sl.addShape(pres.ShapeType.rect, { x:7.0, y:1.25, w:6.0, h:0.45, fill:{color:"5B4A8A"} });
  sl.addText("OUTCOME STATISTICS", { x:7.0, y:1.25, w:6.0, h:0.45, fontSize:13.5, bold:true, color:C.white, align:"center" });

  const stats = [
    ["90%+", "Neonatal BPP eventually resolve without surgery"],
    ["70%", "Develop glenoid hypoplasia with significant IR contracture"],
    ["6 mo", "Lack of biceps function at 6 months = poor prognostic sign"],
    ["83%", "Patient satisfaction after brachial plexus surgery (Kretschmer 2009)"],
    ["18–24 mo", "Muscle fibrosis occurs after this period — act early"],
    ["~1 mm/day", "Rate of peripheral nerve regeneration"],
  ];
  stats.forEach((s, i) => {
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// =====================================================================
// SLIDE 15 — SUMMARY / THANK YOU
// =====================================================================
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  const keys = [
    "Brachial plexus palsy involves C5–T1 nerve roots; Erb's palsy (C5–C6) is most common with best prognosis.",
    "Physiotherapy must begin EARLY — PROM from Day 1 to prevent contractures and glenoid dysplasia.",
    "Seddon/Sunderland classification guides prognosis: neurapraxia recovers fully; neurotmesis requires surgery.",
    "Assessment tools: AMS (neonates), Mallet classification, MRC scale, DASH questionnaire.",
    "Management phases: Acute (PROM, splinting) → Subacute (AROM, NMES) → Recovery (strengthening, functional training).",
    "Electrotherapy (NMES/FES) retards denervation atrophy and facilitates motor re-education.",
    "Multimodal approach: PT + NMES + CIMT + kinesio taping + splinting + family education = best evidence.",
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  sl.addText("Sources: Miller's Review of Orthopaedics 9e • Bradley & Daroff's Neurology • CHOC PT Guidelines 2023 • PMC 2024 Reviews", {
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// =====================================================================
// WRITE FILE
// =====================================================================
pres.writeFile({ fileName: "/home/daytona/workspace/brachial-plexus-ppt/Brachial_Plexus_Palsy_Physiotherapy.pptx" })
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