abstract book

1 49th Annual Conference of Indian Association of Physiotherapists

Academic Partners

Conference Proceedings -Abstracts


Contents

SECTION CATEGORY PAGE NO

1 Cardio - Respiratory Section - Platform Papers 3

2 Cardio - Respiratory Section - Digital Papers 28

3 Musculoskeletal Section - Platform Papers 39

4 Musculoskeletal Section - Digital Papers 63

5 Neurosciences Section - Platform Papers 79

6 Neurosciences Section - Digital Papers 105

7 Community Based Rehabilitation Section - Platform Papers 118

8 Community Based Rehabilitation Section - Digital Papers 127

9 Miscellaneous Section - Platform Papers 137

10 Miscellaneous Section - Digital Papers 143

11 Sports Section - Platform Papers 149

12 Sports Section - Digital Papers 154

13 Paediatrics Section - Platform Papers 159

14 Paediatrics Section - Digital Papers 168

15 Electrotherapy Section - Platform Papers 175

16 Electrotherapy Section - Digital Papers 185

17 Manual Therapy Section - Platform Papers 189

18 Manual Therapy Section - Digital Papers 208

19 Innovative Paper Section 216


CARDIO-RESPIRATORY SECTION

PLATFORM PAPERS


ABSTRACT NO 2 (CARDIO-RESPI 1)

A STUDY ON THE EFFECTIVENESS OF SUPERVISED HOME BASED

EXERCISE PROGRAM IN PHASE II CARDIAC REHABILITATION.

Dr. Roopesh Thomas, Dr. Venkatesh.N Sri Ramachandra College of Physiotherapy, Chennai -109.

AIM: To find if the supervised home based exercise program in phase II cardiac rehabilitation would be effective in terms of increasing exercise capacity (VO2 Max) when compared to conventional non supervised home based exercise programs. OBJECTIVE OF PRESENTATION: To improve the rehabilitative progress of the post CABG patients. METHODOLOGY: The design is a quasi experimental study to find out the effectiveness of the phase II cardiac rehabilitation between the supervised (experimental) group and non Supervised or conventional (control) group. SAMPLE POPULATION: Post CABG patients who is waiting for discharge. SAMPLE SIZE: Ten sample per group. SAMPLING TECHINIQUE: Random selection INCLUSION CRITERIA: Patients of post CABG surgery, Patients with low to moderate in risk stratification, Patient with ejection fraction > 55%, Patients with age group between 45 yrs and 75yrs. EXCLUSION CRITERIA: Patients other that CABG surgery, Patients with High risk stratification, Patient with ejection fraction < 55%, Patients with congestive cardiac failure, Patients with any forms of orthopedics problems which prevents them from walking, Patients with pulmonary disorders. OUTCOME MEASURES: The study is to find the effectiveness of phase II Cardiac Rehabilitation between two groups, Six Minute Walk Test was selected for the study. Each patient was made to walk and monitored with attached portable pulse oximeter which will sense the Heart Rate, Oxygen saturation during the test. The readings of the vitals before, during and after the test was noted and documented. The patient’s fatigue was quantified using Borg’s Scale and dyspnea using New York Heart Association (NYHA) classification for breathlessness, before, during and after the Walk Test. A detail evaluation of the present condition of the patient is done each time the test is conducted. The evaluation includes the risk stratification. After one month when the patients comes for review the feedback and the history of that month’s intervention is verbally obtained to ensure the level of training the individual obtained.. The same six minute walk test is conducted in a similar way and the progression calculated. DATA COLLECTION AND ANALYSIS: Data’s were analyzed by using SPSS for windows version 17. (Statistical package for social sciences).Demographic variables in Categorical/dichotomous were given in frequencies with their percentages. The P<0.05 was considered statistically significant. RESULTS: There is a significance difference in exercise capacity of patients who were involved in supervised home based rehabilitation when compared to the conventional home based rehabilitations. Thus there is increase in exercise capacity when the phase II cardiac rehabilitation is supervised and guided. CONCLUSION AND CLINICAL SIGNIFICANCE: The results of this study suggest that there is significance difference in both the groups after a period of intervention. The per-training test MET’s show equal ranges between both the groups. There is no significance difference in there is exercise capacity prior to the training. But after the training there is significance difference in post training test. The supervised group showed more difference and thus the hypothesis was proved. This study also suggests that simple exercise tolerance test prior to discharge from hospital will make an impact on the phase II cardiac rehabilitation. The level achieved in the exercise testing will be the base line for the further improvement and prognosis of their condition. KEY WORDS: 6 min. Walk test, exercise testing, MET’s, Borg’s scale EMAIL: [email protected]



EFFECT OF ABDOMINAL BINDER ON RESPIRATORY MUSCLE FUNCTIONING OF A TETRAPLEGIC PATIENT IN SUPINE,

RECLINED AND SITTING POSITIONS

Darshika P. Dhandhusaria, Dr. Raziya Nagarwala

Sancheti Institute, College of Physiotherapy BACKGROUND AND PURPOSE: Respiratory system dysfunction accounts for many of the complications of individuals with cervical spinal cord injury and has been related to respiratory muscle paralysis. Any kind of interruption, like cervical spinal cord injury leading to loss of muscular effort will cause respiratory dysfunctions with fatal prognosis. The objective of the study was to know effectiveness of abdominal binder on inspiratory muscle strength of a tetraplegic in three most routinely used positions, supine, reclined to 45 degrees and sitting. STUDY DESIGN AND METHODOLOGY: Study design: Pre and post experimental study Sample size: 30 Inclusion criteria: Tetraplegic patients with level of affection C5 to C8, Medically and surgically stable condition Exclusion criteria: Not willing to participate, Tetraplegic patients with level of affection above C5 and below C8, Medically or surgically unstable condition, Associated head injury, Rib fracture, Abdominal injury, Patients with present history of any respiratory or cardiac condition which can affect the outcome of study or limit patient to be the part of the study Study population: Tetraplegic patients, 25 males and 5 females with a mean age of 31.55 (± 9.56) Abdominal binder was given in a selected starting position after patient’s evaluation. PImax was recorded three times both pre and post intervention. These readings were repeated for all the three position. RESULTS: The data thus obtained was statistically analyzed. PImax value showed significant change from p value. The mean significant improvement, post intervention was, in Supine (pre= -86.16 cm H2O, post= -107.83 cm H2O), Reclined (pre= -84.33 cm H2O, post= -104.33 cm H2O) and Sitting position (pre= -68.83 cm H2O, post= -88.16 cm H2O) There was no significant difference between positions when they were compared to each other post intervention (mean difference for supine= 20.5, reclined=22, sitting=25.33) CONCLUSION: Thus abdominal binder is effective in improving inspiratory muscle functioning of tetraplegic patients in all supine, reclined and sitting positions. Also, no position is superior over another post intervention. CLINICAL SIGNIFICANCE: A simple modification like use of an abdominal binder can significantly help to overcome respiratory problem by facilitating breathing in patient preferred position. KEY WORDS: Tetraplegia, PImax, Position EMAIL: [email protected]



COMPARATIVE STUDY OF EFFECT AEROBIC TRAINING AND PRANAYAMA ON RESTING RPP IN MODERATIVE

HYPERTENSIVE INDIVIDUALS

Abhijit Patil, Mrs. Raziya Nagarwala, Mrs. Shweta Gore

Sancheti Institute College of Physiotherapy, Shivaji Nagar, Pune 05. INTRODUCTION: Systemic arterial hypertension is a highly prevalent disease, affecting approximately 1 billion individuals worldwide and is a major cardiovascular risk factor associated with increased all-cause and cardiovascular mortality. In the present study, we have aimed to know the effects of Pranayama and aerobic training on hypertension. AIM & OBJECTIVES:

1. To find effect of Pranayama and aerobic training on resting rate pressure product in moderate hypertensive individuals.

2. To find out which of the two significantly affect the resting rate pressure product in moderately hypertensive individuals.

MATERIALS & METHODOLOGY: Design: Cross sectional interventional l study. Sampling: - convenient. Setting: Tertiary care centre. Inclusion criteria: - patients taking anti hypertensive medication regularly. Exclusion criteria: - patients not taking medications, and with orthopaedic, neurologica, respiratory impairments. Participants: Sample size 30 moderately hypertensive individuals who were taking anti hypertensive medications regularly. Outcome measures: Resting Rate Pressure Product. Intervention: A prior informed consent being taken. 30 patients were divided into aerobic training group and pranayama group. Aerobic training group had undergone stress test to know maximum heart rate and they were made to exercise 50 to 80 % of maximum heart rate. Both the groups had undergone training for 20 mins for 6 weeks. Statistical analysis: - pair and unpair T test. RESULTS & CONCLUSIONS: The data thus obtain was stastically analyzed using pair and UN pair T test. The results showed that there was reduction in blood pressure in both the groups however changes in aerobic training (P = 0.000) are statically significant over Pranayama (P= 0.30). There was reduction in heat rate clinically in aerobic training group, though it was not stastically significant (P = 0.8). However in Pranayama group there was a rise in heart rate post intervention and it was not stastically significant (P= 0.2). As far as between groups comparison is concerned, aerobic training was found to be stastically significant over Pranayama in reducing rate pressure product (P= 0.023). Thus, conclusion drawn from study is that aerobic training found effective in reducing rate pressure product i.e. (reducing resting oxygen consumption) over Pranayama in hypertensive individuals. KEY WORDS: rate pressure product, hypertension, aerobic training, pranayama. EMAIL: [email protected]



EFFECT OF VERBAL ENCOURAGEMENT AND VISUAL BIOFEEDBACK ON PEAK EXPIRATORY FLOW RATE IN

HEALTHY YOUNG SUBJECTS

Dr. Dipali Rana, Dr. M. Balaganpathi

Charotar institute of physiotherapy, Changa, Gujarat. AIM OF STUDY: To assess the effect of verbal encouragement and visual biofeedback on peak expiratory flow rate. PURPOSE OF STUDY: Peak expiratory flow rate is simple and common method of measuring airway obstruction. The purpose of this study is to find out the effects of verbal encouragement and visual biofeedback during the performance of peak expiratory flow. METHODOLOGY: Study design: Cross sectional study Sample population and Sample size: 60 Healthy young subjects, first and second year B.P.T. students of Charotar institute of physiotherapy, changa, Gujarat were selected, between the age group of 17 to 20 years. Sampling technique: Simple random sampling Students were briefly stated about the nature and intervention of the study and informed consent were taken from them. The method of peak expiratory flow was demonstrated to all subjects. After checking for inclusion and exclusion criteria each participant was randomly selected and assigned to two different orders of peak expiratory flow rate (PEFR) assessments. Each subject went through peak expiratory flow rate assessments including with an intervention (verbal encouragement and visual biofeedback) and without the intervention (without verbal encouragement and visual biofeedback). Inclusion criteria: Healthy subjects, irrespective of sex, of the age group 17-20 years. Subjects who are able to comprehend commands/ visual feedback And willing to participate. Exclusion criteria: Presence of any recent illness, subjects who had received regular use or guidance on technique with PEFR, Smokers, Asthmatics Outcome measure: Peak expiratory flow rate by peak flow meter Statistical analysis: Data were collected with and without intervention. Data were analyzed by paired t-test. RESULTS: Results shows a significant difference in PEFR with p value < 0.0001. Without intervention PEFR - Mean ± SD =290.50 ± 91.270 With intervention PEFR - Mean ± SD =341.67 ± 85.552 With verbal encouragement and visual biofeedback the values of PEFR is higher than without it. CONCLUSION: The efficiency and reproducibility of peak expiratory flow can be affected by verbal encouragement and visual biofeedback during PEFR measurements. KEY WORDS: peak expiratory flow rate, verbal encouragements, visual biofeedback. EMAIL- [email protected]



EFFECT OF DIFFERENT INSPIRATORY MANEUVER ON LUNG FUNCTION TEST (LFT)

Fatema M, Vijayakumar M

Padmashree Dr. D.Y.Patil College of Physiotherapy, Pimpri, Pune INTRODUCTION: LFT is a good measure of how much air is move in and out of the lung. Various studies showed that the fast maneuver is more effective than slow maneuver with 5-7 second pause. According to American thoracic society recommendation, <2sec pause used. AIM OF THE STUDY: To identify an effective inspiratory maneuver for lung function test. Objectives of the study: To compare the effect of slow inspiratory maneuver and fast inspiratory maneuver on lung function test. Methods: Study design: Non-experimental descriptive analytical design Sample population:120 Normal healthy individual Study type: crossover study Sampling techniques: simple random sampling technique. Inclusion criteria: Subject from 18 to 25 years of age, from both sexes, with normal PFT values and willing to participate. Exclusion criteria: Subject with pulmonary and cardiac diseases, with abdominal and eye surgery, with any neurological diseases and Obese individual. PROCEDURE: Fast maneuver done by fast inspiration followed by fast expiration, slow maneuver done by normal inspiration with <2second pause. Fast maneuver and slow maneuver done by spirometry and peak flow meter. Each maneuver done three times and best of three noted as final reading. Outcome measures: FEV1, FVC recorded by spirometry and PEFR recorded by peak flow meter Data analysis: Unpaired t-test was used to compare between fast and slow maneuver. RESULT: t-value for PEFR is -2.008 which shows the significant difference between the fast and slow maneuver where t-values for FEV1 is - 0.987 and FVC is -1.414 which shows statistically not significant(p<0.05). CONCLUSION: This study indicates that the fast and slow maneuver gives similar values of lung function test. CLINICAL SIGNIFICANCE: Fast inspiration followed by fast expiration causes bronchospasm in some individual, so slow maneuver helps them to give appropriate values and vice versa. KEYWORDS: Lung Function Test (LFT), Fast maneuver, Slow maneuver. EMAIL: [email protected]



EFFECT OF BUTEYKO BREATHING TECHNIQUE ON DYSPNEA

Nimesh Varlekar

S B B College of Physiotherapy, Ahmedabad, Gujarat, India BACKGROUND: There are many breathing techniques which can be incorporated in the management of dyspnea. Buteyko Breathing Technique is one of the less known and less practiced breathing techniques in India. There is lack of evidence to demonstrate its impact on heart rate and oxyhemoglobin saturation. And also, studies on numbers of breaths required to relieve dyspnea are unavailable. So, this study tried to see the effectiveness of Buteyko Breathing Technique on dyspnea. AIM & OBJECTIVE: To identify the number of breaths to relieve dyspnea and analyze the effect of Buteyko Breathing Technique on heart rate and oxyhemoglobin saturation. METHODOLOGY: a) study design – observational study b) sample population- 50 volunteers c) sampling method/technique which u used for sample collection - random d) outcome measure – heart rate (beats/minute), oxyhemoglobin saturation (%), breath holding time (second), number of breaths to relieve dyspnea e) method of data collection and statastical test used for data analysis – A single centre, double blind study was conducted to assess the effect of Buteyko Breathing Technique on dyspnea. A total of 50 volunteer were recruited in the study. Adult male or female physiotherapy students who were willing to participate in the study were included. Whereas subjects with sinusitis, headache, vertigo, family history of asthma and history of precipitating factors for cardiovascular disease were excluded from the study. Subjects were instructed regarding breathing maneuver and they were asked to perform the same after the induction of dyspnea P value was calculated to find out the clinical significance. RESULTS: There was a statistically significant increase in heart rate (p < 0.0001). Although oxyhemoglobin saturation improved in majority of subjects, it was statistically non-significant. The mean breaths taken to relieve dyspnea were 12.43±2.42. CONCLUSION AND CLINICAL SIGNIFICANCE: It was concluded that Buteyko Breathing Technique helped in regaining control over dyspnea in brief period of time. Hence, it may be implemented in patients with dyspnea to improve their quality of life. However, further study is required to support these findings in patients with asthma and cardiovascular disease. KEYWORDS: Buteyko Breathing Technique and Dyspnea. EMAIL: [email protected]



“PRANAYAMA”AS A TOOL FOR WEIGHT REDUCTION & ITS IMPACT ON CARDIOVASCULAR AND PULMONARY SYSTEM IN

MULTIPAROUS ASYMPTOMATIC OBESE WOMEN.

Ms Rashmi P. Deshmukh 1, Prof.(Dr). Bharati Bellare 2 1: D.E.S College of Physiotherapy, Pune

2: M.G.M School of Physiotherapy, Vashi

AIM:-“Pranayama” as a tool for weight reduction & its impact on Cardiovascular & Pulmonary system in multiparous asymptomatic obese women. OBJECTIVE:- To compare the following pre & post interventional parameters : Blood Pressure [BP], Respiratory rate [RR], Pulse rate [PR], Body Mass Index [BMI], Abdominal girth, Total lipid profile-triglycerides, HDL, LDL, Serum cholesterol, Score of SF-36 for assessing Quality of life PURPOSE:- To study the effect of Pranayama on weight reduction, Quality of life, lipid profile and its impact on Cardiovascular & Pulmonary system in multiparous obese women. METHODOLOGY Study design:- Longitudinal cohort study.

Sample size:- 70 patients were screened, 30 patients were selected as per inclusion criteria.

Population: Physiotherapy Outpatient Department, Public Sector Hospital in collaboration with

Biochemistry Department of Hospital.

Sampling technique: Random selection

Inclusion criteria: Asymptomatic sedentary Multiparus obese women.

Exclusion Criteria: Any known Cardiovascular or respiratory disorder, Those already practicing yoga,

H/O abdominal surgery

Outcome Measures: BP, PR, RR, BMI, Abdominal girth, Quality of life questionnaire (SF36), Lipid profile. Statistical Analysis: The values of the parameters were analyzed using ANOVA test. RESULTS:-

• Pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure and HDL cholesterol did not show any significant change till the end of 8th week.

• There was significant reduction in serum cholesterol (p< 0.05), serum triglycerides (p<0.05), LDL-cholesterol and abdominal girth (p<0.05) at the end of 8 weeks.

• Mean Body mass index was 28.79 at baseline. After the therapy mean BMI had a decrease of 0.24 and 0.49 respectively at the end of 4th and 8th week but changes were not statistically significant.

• Mental Component Summary and Physical Component Summary had an increase which was statistically significant from baseline. CONCLUSION:-

1. The lipid profile i.e. serum cholesterol, Serum triglycerides and LDL have significantly reduced after pranayama treatment, but there was no significant change in HDL post treatment.

2. There was no significant change in the cardio-pulmonary parameters i.e. BP, PR, RR. 3. There was significant reduction in abdominal girth but no change in BMI. 4. Significant improvement in quality of life i.e. both the physical and mental components of SF-36.

CLINICAL SIGNIFICANCE: Pranayama can be included in treating perimenopausal obese women. KEY WORDS: Pranayama, Weight reduction, Lipid profile, Quality of life. EMAIL ADDRESS: [email protected]



COMPARISON BETWEEN THE EFFECT OF CARBOHYDRATE AND ANTIOXIDANT SUPPLEMENT AFTER AEROBIC

TRAINING ON BLOOD LACTATE AND VO2 MAX ON NORMAL UNTRAINED INDIVIDUALS.

Sanhita Pant, Dr P. Dhakshinamoorthy

S.B.S. P.G.I, Balawla, Dehradun. AIM OF THE STUDY:

1. To compare between the effect of carbohydrate and antioxidant supplementation after aerobic training for 2 weeks on blood lactate and VO2 max.

2. To find out which supplement would be more useful to influence blood lactate and VO2 max. METHODOLOGY: Initially 24 subjects were taken, out of which 6 were withdrawn, so finally 18 subjects (7 males and 11 females), mean age 21.72±2 assessed and included according to inclusion criteria. Informed consent obtained and approval ethical committee done.

The study design experimental – comparative. At 0 session, VO2 max measured via Rockport 1 mile test. Blood sample (to measure blood lactate), taken immediately at completion of 1 mile by certified medical lab technology staff. After that random sampling n=6, n=5 and n=7 subjects in group A, B and C respectively. Aerobic Training started after gap of one day. Post-exercise, supplement CHO in group A, Antioxidants in group B, and Placebo in group C, given after 10 minutes of completion of exercise. Total sessions of aerobic training and supplement were 4 sessions per week for 2wks. After 2 weeks, again Rockport test performed to assess VO2 max. Blood sample taken, at the end of test to measure blood lactate. DATA ANALYSIS: One way ANOVA performed comparing the variables between two groups, and paired t test to compare within the group. Significant level has been selected as 0.05. RESULT: The result showed non- significant difference (p>0.05) for VO2 max and blood lactate between the group A(carbohydrate), B(antioxidant), and C(placebo). The mean value of improvement(pre- post) for VO2 max 6.26±3, 3.21±3 and 4.4±2.7 for group A, B and C respectively, and for blood lactate 0.75±1.1, 0.34±0.46, and 0.06±0.5 for group A, B and C respectively. Although statistically the result favored null hypothesis, but looking at the mean score of improvement, type 2 error found, which was later analyzed and power founded to be low. CONCLUSION: Statistically result concluded no difference between carbohydrate and antioxidant supplement after aerobic training. But type II error analysis, and mean score suggest study need to be replicated on higher sample size. KEY WORDS: Carbohydrate, antioxidant, VO2 max, blood lactate. EMAIL: [email protected]



VALIDATION OF ACOUSTIC ANALYSIS IN QUANTIFICATION OF COUGH

T.Senthilkumar, N.Venkatsh, Prakash Boominatha Sri Ramachandra University (SRU), Chennai-116.

AIM: To assess the validity of acoustic analysis of cough sound in the Quantification of cough. OBJECTIVES: 1. To measure and analyze cough sound with Pulmonary Function test and Expiratory muscle strength in normals and patients 2. To find out the correlation between cough sound intensity with Pulmonary Function test and Expiratory muscle strength to establish the validity of acoustic analysis. PURPOSE: Cough is a valuable method of active airway clearance in chest physiotherapy. The available methods for quantification of cough are invasive, hence not applicable for routine clinical use. Recently acoustic analysis of cough is used in clinical diagnosis and to quantify drug effect. Similarly, Quantification of cough would help to understand the changes in patient’s effort and become a means of feedback cough retraining to patient. METHODOLOGY: This was an Observational, analytical study done on three groups of samples comprised of Group I (Normals), II (COPD patients) and III (Restrictive lung condition).Purposive sampling was done including male subjects in age group of 40-70. I- Normal, healthy subjects (n=11); II- COPD patients of more than 2years duration, functionally ambulant without oxygen (n=8); III-Stable, Post median sternotomy patients of low risk category prior to discharge (n=7). Pulmonary function test (PFT) for lung function, Cough sound at Low, mid and high lung volumes was recorded at Acoustics lab and expiratory muscle strength with Maximal Expiratory Pressure (MEP) using sphygmomanometer was done. These data were analysed group wise for correlation between cough sound intensity at different lung volumes with PFT and MEP using Karl Pearson correlation with SPSS package.

RESULTS: The analysis has shown a positive correlation to exist between the PFT parameters (0.707, 0.774, P<0.05), MEP (0.772, P<0.05) and cough sound in patients with COPD; There was a negative correlation between FEV1 (-0.643P<0.05), FVC (-0.772,P<0.01) and cough sound at mid volume while showing significant positive correlation between MEP and High volume among normals (0.870,p<0.01). There was no significant correlation obtained in POSTOP patients in this sample studied.

CONCLUSION & CLINICAL SIGNIFICANCE: Acoustic analysis of cough sound would be a valid method to quantify cough among COPD patients but not for Normal subjects and Postoperative(CABG) patient samples. Further studies among normals with induced cough and restrictive lung disease patients without pain interference, and in larger sample would be needed before generalization.

KEY WORDS: Acoustic analysis, Cough sound, Pulmonary Function test, Maximum Expiratory Pressure.

E-MAIL: [email protected]



COMPARISON OF ESTIMATION OF VO2 Max. IN HEALTHY ADULTS AND ADULT WITH TYPE 2 DIABETIS DURING 1 MILE WALK TEST.

DHANANI SHWETA B., BY DR. SWEETY SHAH

S.B.B. COLLEGE OF PHYSIOTHERAPY, AHMEDABAD.

OBJECTIVE OF STUDY : The aim of study is to compare Vo2 max. in healthy adults and adult with type 2 diabetic during 1 mile walk test. PURPOSE : Diabetic mellitus is a disorder that is characterized by high blood glucose in the context of insulin resistance and related insulin deficiency. Complex and multifactorial metabolic changes lead to damage and functional impairment of the cardiovascular system. Vo2 max. is maximum capacity of and individual body to transport and use O2 during incremental exercises which reflect the physical fitness of the individual. It is dependent on the transport of O2, O2 binding capacity of blood, cardiac function, O2 extraction capabilities and muscular oxidative potential. ROCKPORT FITNESS WALKING TEST ( 1 mile walk test ) It is a simple self paced test to predict aerobic power. VO2max (ml·kg-1·min-1) =88.768 + 8.892 (gender) – 0.0957 (BM lb) – 1.4537 (T) -0.1194 (HR) gender = 0 for women, and 1 for men BM = body mass (pounds) in walking shoes T = time to walk 1 mile HR = immediate post-exercise HR (beats/min) METHODOLOGY: STUDY DESIGN - comparative study SAMPLE SIZE -20 healthy adults (Group A ) 20 adults with type 2 D. M. ( Group B ) SAMPLI NG TECHNIQUIE – random sample selection INCLUSION CRITERIA-( it include both male & female age between 50-59 years having B.M.I. 21-25 kg/m2 ) Group A - healthy adults Group B - adults with type 2D.M. EXCLUSION CRITERIA- pulmonary,cardiovascular,musculoskeletal,neurological diseases. OUTCOME MEASURE- Time for 1 mile walk, Peak HR,Vo2 max DATA COLLECTION-Subjects were divided into 2 Group.Subjects were explained the procedure and consent was taken.Before test the resting HR, RR, Age, Height, weight were taken.Subjects were asked to walk 1 mile over ground at their maximum possible speed without rest in between.After the walk 15 sec. HR were taken.The values of the measurement were put into the formula and Vo2 max. calculated. t test was applied for data analysis. RESULTS : mean of Vo2 max. of healthy adults is 43.54 (ml·kg-1·min-1) and mean of Vo2 max. of adult with DM is 37.98 (ml·kg-1·min-1)mean difference was significant at t=4 & p<0.05 CONCLUSION : Individual with type 2 D.M. have reduce Vo2 max. then healthy adults. KEY WORDS : Type 2 D.M.,Vo2 max.,1 mile Rockport test E-MAIL: [email protected]



SHORT TERM EFFECTS OF FLUTTER DEVICE AND POSTURAL DRAINAGE ON PEAK EXPIRATORY FLOW RATE AND CHEST EXPANSION IN CHILDREN WITH SECRETION RETENTION

Dr. Prachi Mulik, Dr. Shaila Sabnis

Sancheti Institute of Orthopaedics & Rehabilitation, Pune AIMS : To compare short term effects of Conventional Chest Physical Therapy and Oscillating Positive Pressure using Flutter device on Peak Expiratory Flow Rate and Chest Expansion in patients with secretion retention. OBJECTIVES: 1. Effects of Conventional physical therapy on Peak Expiratory Flow rate & Chest expansion.

2. Effects of Oscillating Positive pressure on Peak Expiratory Flow Rate & Chest Expansion METHEDOLOGY Study Design – Two group Pre-Test Post-Test Design. Population – Children 6 to 14 years. Sample size –Thirty patients. Sampling technique –Patients were assessed, divided in two groups. Pre-treatment Peak Expiratory Flow Rate [PEFR], Chest Expansion at three levels upper, middle, lower zones were measured. Group A patients were sitting with flutter device in mouth while exhaling through it. Patient repeated technique for 5 – 10 breathes to loosen mucus, held breathe for 2-3 seconds & exhaled. Session time 25–30minutes. Group B received therapy with postural drainage positions. Percussions, Vibrations were given in each position. Position was maintained for 4-5minutes. Session duration 30minutes. After treatment and one hour post-treatment, PEFR, Chest Expansion were measured. Inclusion criteria Patients diagnosed for : Bronchopneumonia, Lower Respiratory Tract infection, Atelectasis due to mucus plugging/ Secretion retention Exclusion criteria Patients diagnosed for : Pleural effusion/Empyema/ Pneumothorax, Tumors of lung, Pulmonary edema, Patient’s undergone pulmonary/ cardiac surgery Outcome measures: PEFR, Chest Expansion at 3levels. Data collection & analysis: Baseline difference between 2 groups tested using unpaired t test . Within group differences( Post – Pre scores, 1 Hour Post – Pre scores )tested using paired t test[ p<0.05]. The difference in the mean change of PEFR, chest expansion in both groups tested using unpaired t- test[ p<0.016]. RESULTS: GroupA significant improvements noted in PEFR (t= -6.44, t = + 4.38) Chest Expansion (t = -3.76 t = -5.50). Group B significant improvement was noted in PEFR(t = -1.55, t = + 3.29), Chest Expansion( t = +1.97, t = +2.26,p<0.05). Difference in mean change of PEFR Chest Expansion analyzed using unpaired t test to find more effective technique, results were not significant for PEFR(t = 0.73, t = - 1.69), Chest Exapansion(t = -1.66, t = +1.44, p>0.016). CONCLUSION: Both Flutter device & Postural Drainage are safe, effective in removing secretions. CLINICAL SIGNIFICANCE: Flutter is an excellent alternative to conventional methods of airway clearance. KEY WORDS: Flutter, Postural drainage, secretion retention. EMAIL : [email protected]



HAEMODYNAMIC EFFECTS OF ABDOMINAL AND CORE EXCERISES IN HYPERTENSIVES

Dr. Payal Jain, Dr. Sneha Lad

CMF’s College of Physiotherapy, Nigdi, Pune PURPOSE OF THE STUDY: Lifestyle changes have made low back pain one of the very common musculoskeletal disorders affecting 80% of people at some point in their lives. Preventive and treatment plan for these disorders usually includes dynamic abdominal and/or core stability exercises. But different type of exercises has varied haemodynamic effect. Hypertension is another lifestyle disorder affecting major population. So, whether these haemodynamic changes of exercises can be a risk in patients with diagnosed hypertension. AIM: To compare hemodynamic effects of dynamic abdominal and core exercises in hypertensives. OBJECTIVES: 1) To record the pre exercise systolic and diastolic pressure and pulse rate in normotensive and hypertensive. 2) To administer dynamic and core exercises to each group 3) To record post exercises hemodynamic changes and analyze the results METHODOLOGY Study Design: Comparative study Sampling technique: Randomized Sample Size: 30 Inclusion Criteria: Group A: Both genders, grade 3 abdominal strength, 45-65 years, normotensives Group B: Both gender, grade abdominal strength, 45-65 years, hypertensive (diagnosed and under medication) Exclusion Criteria: Group A: No haemodynamic & musculoskeletal ( related to back) pathology Group B: No haemodynamic pathology other than hypertension & no musculoskeletal pathology related to back. PROCEDURE: Group A: 15 Normotensive. Basal parameters were recorded. Dynamic abdominal exercises – straight and oblique curl ups, bridging, SLR, Hip knee 90-90 (rocking) followed by parameter readings Pre and post Core stability exercises (Level 3 and 4) parameters. Group B: 15 Hypertensive. Exercise protocol as for Group A DATA ANALYSIS: paired t test was applied to compare the haemodynamic (Systolic & diastolic pressure & Pulse rate) changes after the dynamic abdominals & core exercise protocol. RESULTS: Group A (Normotensive) there was significant difference in systolic and diastolic B.P. and pulse rate (SBP, p= 0.0069; DBP, p= 0.0281; PR, p=0.035) in core stability exercises when compared with dynamic exercises. Group B (Hypertensive) there was no significant difference in systolic B.P (p=0.2971) between the two exercise protocols. However the same caused a very significant and significant difference in the diastolic pressure and pulse rate respectively (DBP,p=0.0001; PR, p=0.0487). CONCLUSION & CLINICAL SIGNIFICANCE: In hypertensive the diastolic BP fluctuates drastically with core stability exercises as compared to dynamic exercises. Thus while prescribing the core exercises precaution has to be taken in ‘at risk’ patients. KEY WORDs: Blood Pressure, Core, dynamic abdominal exercises EMAIL: [email protected]



RELIABILITY OF 20 METER SHUTTLE TEST AND ROCKPORT 1 MILE WALK TEST FOR MEASURING VO2 MAX

Dr. Prahlad Priyadarshi 1, Dr. Rahul Singh Parihar 2

1: College of Applied Education And Health Sciences Meerut 2: SBS PGI, Dehradun

INTRODUCTION: The single most reliable and valid measure of aerobic capacity is the maximal oxygen consumption, or VO2max. Although direct measurement is the single best measure of cardio respiratory fitness or aerobic capacity, laboratory tests of vo2 max involve complexities and require extensive and sophisticated equipment, are time consuming and have a large financial cost. . Laboratory tests are also restricted to exercising on a treadmill, cycle or simulation ergo meter with the subject required to wear a mask which is attached to a gas analyzer, and requires the subject to remain close to the equipment.1 Cardio respiratory endurance is generally recognized as a major component of evaluating physical fitness and maximal oxygen consumption(vo2max) and is consider the most valid measure of cardio respiratory fitness2. VO2max is a measure of the maximal amount of oxygen that can be used by a person during exhaustive exercise. There are two most common indirect method of assessing vo2max is 20mst and Rockport one mile walk test. The 20metre multistage shuttle test is a versatile field test. the test which was originally designed by leger & lembart(1982)and later refined by leger et al (1988) is popular field test of aerobic power. PURPOSE OF STUDY: The purpose of this study is to find out20mst and Rockport one mile walk test is reliable method for measuring vo2max.

Design of Study: Correlation Materials used: Beep test audio CD, Motorized Treadmill. Research setting: Research laboratory, physiotherapy department, SBSPGI Dehradun. PROCEDURE: After selecting 60 subjects of mean age 21.4+ 1.84 years. All subject first20mst and 1week gap rockport1 mile walk test performed this procedure repeated twice. Data analysis- RESULT The Rockport 1 mile walk test shows the average 51.849 and standard deviation of ±2.869 and 20 meter shuttle test average 36.813 and standard deviation of ±10.463,The mean value also less than the initial reading, after performing ICC (Intraclass correlation coefficient) standard error of measurement on SPSS Version (16),2006 CONCLUSION: Both methods are equally reliable but the results of Treadmill method is more consistence then the Beep test method. KEYWORDS: VO2 max, Ground test (20 MST), Rockport 1 mile walk test. EMAIL: [email protected]



THE EFFECT OF RESISTANCE TRAINING ON FUNCTIONAL FITNESS IN TRADITIONAL PULMONARY REHABILITATION IN

PATIENTS WITH COPD

Smita U. Bankar, PDVVPF’S, College of Physiotherapy, A.Nagar

AIM- To investigate the effect of resistance training on functional fitness in traditional pulmonary rehabilitation in patients with COPD OBJECTIVES

1. To investigate the effect of a traditional endurance Pulmonary rehabilitation programme (ET) on functional fitness in older individual with COPD

2. To evaluate the complementary effects of a single set resistance training programme (RT) on these outcomes

3. To compare traditional endurance Pulmonary rehabilitation programme with addition resistance training to a traditional Pulmonary rehabilitation programme in patients with COPD PURPOSE-Functional fitness is important for persons with COPD who have skeletal muscle weakness, which contributes to impaired functional health & increased use of health care services. So this study was taken to find out the effect of resistance training on functional fitness in traditional endurance pulmonary rehabilitation patients with COPD METHODOLOGY Study design- A randomised controlled trial Sample population & size- 24 patients of COPD aged 60-80yrs Sampling technique- purposive sampling Inclusion criteria- Diagnosis of COPD, Ability to participate in resistance training Exclusion criteria- History of recent surgery, Haemodynamically unstable patient ,Acute heart & other systemic diseases, Intervention 8 week (16 session,2 session/week) ET group- education, breathing exercises, psychosocial support, upper & lower body aerobic, RT group- ET with addition of resistance training (incline leg press, seated leg press, lat pulldown, cable triceps pushdown, cable biceps curl) Outcome measures- Functional fitness outcomes-Modified sit & reach, Chair stand (repetitions), Scratch test Up & go, Arm curl(repetitions), 6-min Walk test, Lift & reach (repetitions) Data collection & Analysis- All prescore & postscores were reported as mean ±SE unpair t-test used to examine presore & postscore, Paired t test were used to asses significant changes within groups RESULT Functional fitness improved significantly in RT group for all measures except the modified sit & reach test, Scratch test. Improvement in ET group were significant only for the arm curl & 6-min Walk. A significant difference (p<0.05) between the RT & ET groups was found for the Lift & Reach test CONCLUSION The addition of RT to a traditional Pulmonary rehabilitation programme can elicit significant improvement in functional fitness that are not obtained by traditional pulmonary rehabilitation alone KEY WORDS- Traditional endurance Pulmonary rehabilitation, Functional fitness, Resistance training, COPD EMAIL- [email protected]



REFFECTIVENESS OF BREATHING EXERCISES VERSUS YOGA (PRANAYAMA, ASANA) IN IMPROVING LUNG FUNCTION ON

PATIENTS WITH BRONCHIAL ASTHMA - A COMPARATIVE STUDY

Keerthika, Anto V, Sam T

Alva’s College Of Physiotherapy, Moodbidri. AIM AND OBJECTIVE: To compare the effectiveness of breathing exercise versus yoga (pranayama, asanas) in improving the lung function on patients with bronchial asthma. PURPOSE OF STUDY: The incidence of bronchial asthma globally is on an upsurge and it has been a major cause of morbidity and mortality. The 2009 statistics pertaining to incidence of bronchial asthma reveal that in India an enormous 15 million people suffer from asthma. Pharmacological management although available, it adds to financial burden, morbidity and mortality apart from the complications and side effects of pharmacotherapy. The evidence to support the benefits of breathing exercises and yoga as an intervention in the treatment of bronchial asthma is growing. The growing popularity of unconventional approaches to treating bronchial asthma fueled our interest in the possible antiasthmatic effects of breathing exercises and yoga. METHODOLOGY: Study design: the study was experimental in nature. Sample population and sample size: thirty four subjects were selected from the population that fulfilled the selection criteria. Sampling technique: simple random sampling (lottery method). Inclusion criteria: medically stable patients with stage 1 bronchial asthma of both genders in the age group 30 -40 years. Exclusion criteria: psychologically unstable patients, patients with associated medical disorders and patients on regular corticosteroid, bronchodilator and inhaler therapy. Outcome measure: Spirometric measurement of forced expiratory volume in one second and peak expiratory flow rate. Method of data collection: primary data was collected pre and post intervention. Statistical test used for data analysis: paired t test and independent t test. RESULTS:

• Results of paired t-test show that there is statistically significant improvement in the forced expiratory volume in one second and peak expiratory flow rate in both groups after intervention.

• Result of independent t-test shows that there is no statistically significant difference between both groups after intervention.

CONCLUSION: Results of the study lead us to conclude that breathing exercise and yoga are equally effective in improving lung function in bronchial asthma. KEY WORDS: asthma, yoga, breathing exercises. EMAIL ID: [email protected]



EFFECT OF EXERCISE TRAINING ON QUALITY OF LIFE AND FUNCTIONAL CAPACITY IN HEAD AND NECK CANCER PATIENTS

RECIEVING CHEMO-RADIOTHERAPY: A CASE SERIES

Samuel S R, Maiya G A, George M M

Department Of Physiotherapy, Manipal College of Allied Health Sciences, Manipal

University, Manipal INTRODUCTION- Head & neck cancer accounts for about one third of all cancers in India. Several studies have reported that these patients suffer from reduced functional capacity and quality of life due to chemo-radio therapy. However, there is paucity of studies on the effect of exercise training on altered functional capacity and quality of life in Indian cancer patients. OBJECTIVE- To find out the effects of exercise training on functional capacity and quality of life in patients with head and neck cancer undergoing chemo-radiotherapy. METHODOLOGY Study Design- Case series Sample Population-Head and neck cancer patients undergoing chemo-radiotherapy at Shirdi Sai Baba cancer hospital, Manipal Sampling -Convenience sampling. Sample Size-5 Inclusion Criteria- Patients receiving chemo-radiotherapy for head and neck cancer having Eastern Cooperative Oncology Group Score < 2 were included. Exclusion Criteri- Patients having platelet count<15,000 and patients with severe orthopedic and neurological problems. Intervention- All patients were clinically evaluated before the commencement of chemo-radiotherapy and prescribed individually tailored moderate intensity aerobic exercise (3–5/10 rating of perceived exertion) and resistance exercise program (3–5/10 rating of perceived exertion)5 days a week for the entire 6-week period of chemo-radiotherapy Outcome Measures-The Six minute walk distance and the medical outcome survey questionnaire –Short Form36 were assessed at baseline and at the end of 6 weeks Data Analysis- Descriptive analysis was used to analyze the data. RESULTS-Mean age of the 5 male patients was 54.6±3.48 years (Mean± Standard deviation). The baseline mean six minute walk distance mean was 421.84 ±71.86 meters and the mean six minute walk distance at the end of 6 weeks was found to be 449.88±.27.64 meters. The baseline mean value on the physical component domain of Short Form-36 was 40.2±2 and the mean value on mental component domain was 10.2. ±1 At the end of 6 weeks the physical component mean value increased to 43.9±1.8 while the mental component mean value increased to 30.2±1.4. CONCLUSION -Exercise training was found to be effective in improving the quality of life and functional capacity in head and neck cancer patients undergoing chemo-radiotherapy. CLINICAL SIGNIFICANCE- Head and neck cancer patients undergoing chemo-radiotherapy should be given an individualized exercise training program to improve their quality of life and functional capacity. KEYWORDS- Cancer, exercise, quality of life. E-MAIL- [email protected]



COMPARATIVE STUDY ON EFFICACY OF MODERATE INTENSITY LAND BASED ENDURANCE EXERCISE AND MODERATE

INTENSITY WATER BASED ENDURANCE EXERCISE ON NORMAL YOUNG INDIVIDUALS

Dr. Vishal M. Patle 1, Dr. Devayani Thakre 2

1: Physiotherapy School & Centre, Government Medical College & Hospital, Nagpur

2: Shree Aurobindo Institute of Medical Sciences, Indore, M.P.

AIM: To compare the effectiveness of moderate intensity land based endurance exercise and moderate intensity water based endurance exercise in normal young individuals.

OBJECTIVES:

• To study the effects of land based endurance exercise in normal young individuals.

• To study the effect of water based endurance exercise in normal young individuals.

• To compare the effects of both the exercises in normal young individuals.

METHODOLOGY:

Study Design – Randomized Control Trial

Sample population and size – 50 Normal young individuals, aged 20 to 30 years

Sampling technique – Subjects randomly divided in two groups by chit selection, 25 in each group, one group receiving land based endurance exercise (walking) & the other group receiving water based endurance exercise (swimming).

Inclusion Criteria – Asymptomatic normal healthy young non-smoking individuals, no history of Hypertension, Diabetes Mellitus, Tuberculosis and Bronchial Asthma.

Exclusion Criteria – Presence of any disabling lung disease, congenital or acquired chest deformities, cardiac impairment, neurological disorder or any other musculoskeletal condition,

Outcome measures –

Six Minute Step Up Test, Borg’s Scale for rate of perceived dyspnea, Visual Analog Scale for dyspnea, Peak Expiratory Flow Rate, Resting Pulse Rate

The data on all the outcome measures for subjects in both the groups was collected on day 0 and subsequently on day 7, day 14 and day 21. The data was analyzed on statistical software STATA version 8.0. Categorical variables were presented in percentage. Continuous variables were expressed as Mean + SD. Continuous variables were compared between both the groups by performing unpaired t – test and p ≤ 0.05 was taken as statistical significance.

RESULTS – Subjects in both the groups showed improvements on all the outcome measures on subsequent assessments on day 7, day 14 & day 21 as compared to the baseline assessment values on day 0. Though, the improvements on all the outcome measures were more prominent in the swimming group as compared to that in the walking group.

CONCLUSION & CLINICAL SIGNIFICANCE – Both, walking and swimming, are effective in increasing the cardio-respiratory endurance in normal young individuals, but when compared, swimming is found to be more effective than walking. Water based endurance exercise (swimming) can be used, prescribed and recommended more extensively for cardio-respiratory endurance training.

KEY WORDS – Cardio-respiratory endurance, Dyspnoea, Moderate Intensity Exercise.

EMAIL– [email protected]



COMPARISON OF MECHANICAL VIBRATION AND CONVENTIONAL

CHEST PHYSIOTHERAPY ON LUNG COMPLIANCE IN MECHANICALLY VENTILATED PATIENTS: CLINICAL TRIAL

Ashima Kaul, Kalyan Chakravarthy, Dr. G Arun Maiya

Department of Physiotherapy, MCOAHS, Manipal University, Manipal. OBJECTIVE: To compare the effects of mechanical vibrations and conventional chest physiotherapy on hemodynamic parameters and lung compliance in mechanically ventilated adult patients. METHODOLOGY: Subjects: Mechanically ventilated adult patients admitted in the ICUs of Kasturba Hospital, Manipal. Study Design: Clinical trial Sampling Method: Convenience sampling Sample Size: 24 Inclusion Criteria: Mechanically ventilated adult patients in the ICU. Exclusion Criteria: Patients contraindicated for chest physiotherapy or mechanical vibrations, Hemodynamically unstable patients at the time of the intervention, Patients requiring suction before 4 hours post intervention. PROCEDURE: Screening of the patients with detailed assessment was done and baseline measurements were obtained. The patients were divided randomly into two groups. Group1 received chest physiotherapy (CPT) (positioning, chest wall percussions and manual vibrations) followed by mechanical vibrations (MV) (positioning, mechanical vibrations) vice-verse for group2. Readings of the outcome measures were taken post suction, followed by 15 minutes, 30 minutes then every 30 minutes for 4 hours. Outcome Measures: Primary variable : Lung compliance (LC) Secondary variables: Heart rate (HR), Systolic-diastolic blood pressure (SBP-DBP), Oxygen saturation (SpO2), Respiratory rate (RR) Data analysis: Interim analysis was done using repeated measures ANOVA to compare the results between the two groups at the following intervals Pre-intervention, Immediate post-intervention, 15min, 30min, 60min, 90min, 120min, 150min, 180min, 210min and 250min post treatment. RESULT No differences were observed between CPT and MV for HR (p= 0.499, 0.677, 0.978, 0.076, 0.137, 0.151, 0.616, 0.383) RR (p=0.972, 0.218, 0.302, 0.918, 0.505, 0.080, 0.503, 0.253) SBP (0.122, 0.891, 0.370, 0.385, 0.477, 0.100, 0.152, 0.158), DBP (p= 0.357, 0.954, 0.216, 0.702, 0.733, 0.070, 0.146, 0.081) and SpO2 (p= 0.138, 0.341, 0.341, 0.192, 0.135, 0.191, 0.061, 0.167). Significant difference in LC was observed between the CPT and MV groups for post, 15 minute, 30 minute and 1hour reading (p<0.05) (p= 0.035, 0.015, 0.021, 0.008). CONCLUSION Interim analysis of the study shows that both CPT and MV can be administered to the patients on mechanical ventilation without any significant changes in the hemodynamic parameters. Also both CPT and MV has an significant effect on the improvement of dynamic LC post suction and the effect was seen to last for 1 hour. KEYWORDS: Hemodynamic parameters, ICU, Positioning, Mechanical vibrator. EMAIL: [email protected].



CONSTRUCTION AND CONTENT VALIDATION OF

QUESTIONNAIRE FOR BARRIERS IN CARDIAC REHABILITATION

Dixit Sweta, Bhamini K. Rao

Department of Physiotherapy MCOAHS, Manipal University, Manipal AIM OF THE STUDY : In spite of the benefits of Cardiac Rehabilitation programs, low participation rates are well observed, so aim of the study was to assess the different barriers among the cardiac patients by constructing an questionnaire and then giving it for content validation. OBJECTIVE OF THE STUDY: To form a valid and reliable self designed questionnaire for finding patient’s belief, awareness and the barriers for the potentially lower participation. METHODOLOGY: Sample population: Cardiac patients eligible for cardiac rehabilitation from the cardiac wards of Kasturba Hospital, Manipal. PROCEDURE: A questionnaire was formed by conducting a pilot study at Kasturba hospital, Manipal on 40 patients admitted in the cardiology and cardiothoracic surgery wards. After interviewing the patients, 46 items structured questionnaire was designed on awareness, transport, social barriers, financial constraints, health comorbidities. The questionnaire was later given for content validation in Manipal and Mangalore Kasturba Hospital to all the staff in the physiotherapy department specialized in cardiopulmonary sciences and the cardiothoracic surgeons at Kasturba hospital, Manipal. All the suggestions were taken into consideration and the appropriate changes were incorporated. RESULTS: The questionnaire after content validation by 20 cardiology staff the 46 item questionnaire was changed to 26 item questionnaire with equal number of subdomains. The all domains and subdomains were rated as whether each question was relevant, complete, reproducible, consistent and applicable. CONCLUSION: We constructed a 46 item questionnaire focusing on awareness, transport, social barriers , financial constraints , health comorbidities, depression after content validation with 20 Physiotherapy and Cardiology professionals the number items were reduced to 26 items. KEY WORDS: Exercise, Cardiac rehabilitation, Barriers, Content validity, Questionnaire. EMAIL: [email protected]



TO STUDY THE EFFECT OF ACCUPUNCTURE TENS ON HEART RATE RECOVERY TIME AFTER 12 MINUTE WALK

TEST

Dr. Niyati Bhide, Dr. Prajakta Pangul, Dr. Shilpa Parab CMF’s College of Physiotherapy, Nigdi, Pune

AIM: To study the effect of single session of Acupuncture TENS on heart rate recovery time after 12 minute walk test. OBJECTIVES: To compare the pre and post heart rate recovery time after application of acu TENS PURPOSE: Heart rate recovery after exercise is very important in patients undergoing rehabilitation as early recovery of vital parameters decreases the post exercise body stress. World Health organization has recommended acupuncture to be effective theory and it has role on cardiovascular and autonomous nervous system. Acu TENS was selected so that similar effects can be studied in non invasive way and can be used in the rehabilitation of patients. METHODOLOGY: Study design: Experimental study Sample population and size: 29 Sampling technique: Random sampling Inclusion criteria: Individuals between the age group 17 to 25 years, Both males and females Exclusion criteria: Individuals with cardio respiratory problems, Doing regular exercise, gym or pranayam, Overweight or obese individuals, Smokers Outcome measures: Heart rate recovery time Data collection and analysis: Individuals fitting the inclusion criteria were selected, their written consent was taken and 12 minute walk test was performed. Heart rate recovery time was noted after the test. A 45 minute session of Acu TENs was given to them at PC6 point and the 12 minute walk test was repeated after TENS session. The pre and post TENS heart rate recovery time were noted and data analysis was done. RESULT: The data was analyzed by using paired t test.| t

cal | = 5.46 and | t tab| =

2.048 for 28 degrees of freedom at 5% level of significance. | t cal | > | t

tab| so we reject (H0) and accept (H1) CONCLUSION AND CLINICAL IMPLICATION: A single session of Acu TENS causes faster recovery of heart rate after 12 minute walk test in normal individuals. Early return of post exercise heart rate will help patients undergoing cardiopulmonary rehabilitation to return stabilize more easily after an exercise session and decrease the possibility of hemodynamic instability after exercise. Early return of exercise induced tachycardia will boost the confidence of patient and also will motivate the patient for rehabilitation. KEYWORDS: Acu TENS, Heart rate recovery, 12 min walk test EMAIL: [email protected]



TO EVALUATE THE EFFICACY OF PULMONARY REHABILITATION

IN CHRONIC OBSTRUCTIVE LUNG DISEASE AND INTERSTITIAL

LUNG DISEASE

Dr. Nilesh Makwana, Dr. Nidhi Dixit,

Dr. Rohini V. Chowgule, MD, FCCP (USA),

Dr. S.G. Gangal (MSc, PhD, FASc, FNASc)

Indian Institute of Environmental Medicine.

AIM: To evaluate whether Pulmonary Rehabilitation (PR) is equally effective in both chronic obstructive pulmonary disease (COPD) and in interstitial lung disease (ILD). METHODOLOGY:

• Study Design:-It is a Retrospective Cohort Study. Patients who were referred to the cardiopulmonary rehabilitation centre with diagnosis of COPD and ILD with same severity of diseases.

• Sample Population/Size:-A total of 30 patients [(n=30) 15 COPD and 15 ILD, age 62.06 (±8.86) years (15 Males and 15 Females)], were included out of which 13 COPD and 12 ILD patients have successfully completed 6 weeks of PR.

• Sampling Methods/Technique:- The variables like History, Spirometry, 6 Minute Walk Test (6MWT), Original Borg’s Scale (OBS), Saturation of Oxygen (SPO2), were recorded before & after PR in COPD and ILD, and systematically divided according to their Spirometry results. The rehabilitation program was administered thrice a week for 45 minutes for 6 weeks. The exercise program included Aerobic exercises (Treadmill / cycling), strength training (Depending on their 1 Repetition Maximum) during PR breathing exercises and supplemental oxygen was given, and an increment of exercises depending on their Borg’s score post to the exercises administered.

• Exclusion criterions:- Conditions like unstable angina, myocardial infarction, any orthopaedic condition etc which prevented them to undergo PR, and 5 patients (males 2 and females 3) 2 COPD and 3 ILD were hospitalized due to exacerbation of symptoms.

• Outcome Measures:- There was an improvement in 6MWT, SPO2 and Original Borg’s scale in both COPD and ILD, but improvement in COPD were more compare to ILD.

• Data Collection/Statistical Analysis:-The datas were collected retrospectively. All the recorded datas were then statistically analysed using Paired T test for both ILD and COPD. RESULTS- There was significant change in 6 MWT in COPD and ILD was 53.54 metres and 32.25 metres [±4.14, (p<0.001) and +2.93, (p<0.01)] respectively. There was an improvement in SPO2 in COPD i.e. 2.66 %, and in ILD i.e. 0.58%, both in males and females after 6 weeks of PR. There was also an improvement in Borg’s score in COPD and ILD, But improvement were more in COPD compare to ILD after 6 weeks of PR. CONCLUSION: ILD patients also show an improvement in 6MWT, SPO2 and Borg Scale along with COPD patients. More detailed studies with higher sample sizes are needed for conclusive evidence. KEYWORDS- Pulmonary Rehabilitation (PR), Chronic Obstructive Pulmonary Disease (COPD), Interstitial Lung, Disease (ILD), Saturation of Oxygen (SPO2). EMAIL- [email protected]



VALIDATION OF BREATH HOLDING TIME TEST AS A MEASURE OF CARDIORESPIRATORY FITNESS IN

PATIENTS WITH PARAPLEGIA.

Shail Sanghvi, Dr. Anjali Bhise

Government Physiotherapy College, Ahmedabad. AIM AND OBJECTIVES: 1) To find a normative data of breath holding time in normal healthy individuals of age group 18-30 years. 2) To validate the use of breath holding time test as a measure of cardiorespiratory fitness in patients with paraplegia. 3) To find out the breath holding time in patients with paraplegia of age group 18-30 years. METHODOLOGY: Study design – Observational cross-section study. Sample population – Normal healthy individuals in the age group 18-30 years. Patients with paraplegia in the age group 18-30 years from the Paraplegia hospital, Civil hospital, Ahmedabad. Sample size – Normal individuals = 230. Patients with paraplegia – 100. Sampling technique – Convenience sampling. Inclusion criteria – Normal healthy individuals and patients with paraplegia in the age group 18-30 years., having level of lesion below T8. Exclusion criteria – previous history of any respiratory disease, any acute attack of cough and cold, smokers, patients having autonomic dysfunction. METHOD – The subjects were asked to take a deep inspiration up to approx 80-85% of vital capacity followed by holding the breath for as long as he\she could tolerate. This time was noted. Outcome measures – Personal database, BMI, history, hospital stay were collected. Oxygen saturation was also noted during the apnea phase. Data analysis – The data analysis was done using the Mann-Whitney test for comparison. RESULT – The breath holding time in normals was found to be 42.42 sec (40.34 – 44.39 sec) The breath holding time in paraplegic patients = 22.35 sec (19.18 – 25.52 sec) The difference is extremely significant. Mann-Whitney ‘U’=1063.5 (P< 0.0001) CONCLUSION – Breath holding time test can be used a measure to assess the cardiorespiratory fitness in patients with paraplegia. KEYWORDS – breath holding time test, normal individuals, paraplegia. EMAIL– [email protected]



SNIFF NASAL INSPIRATORY PRESSURE IN HEALTHY INDIVIDUALS IN AHMEDABAD

Arti Gadesha, Anjali Bhise

Government Physiotherapy College, Ahmedabad. PURPOSE To determine normal values of sniff nasal inspiratory pressure for healthy individuals in ahmedabad METHODOLOGY Study type- cross sectional observational Sample size- 100(male & female) Population- students & staff of government physiotherapy college, civil hospital ahmedabad Sampling technique- random sampling Inclusion criteria- Healthy individuals between 18 to 40 years of age Exclusion criteria- 1.subjects having pulmonary disease, heart disease , neuromuscular disease,cerebrovascular disease 2.pregnancy 3.subjects having sinusitis, rhinitis, deviated nasal septam 4.competitive athletes Outcome measure-sniff nasal inspiratory pressure Data collection and analysis- sniff nasal inspiratory pressure of students and staff of government physiotherapy college was measured using Micro Respiratory Pressure Measurement device. Data analysis was done using SPSSfor windows. Mean and SD were calculated. RESULTS Mean and SD values of sniff nasal inspiratory pressure for gender are 55.0±28.9 cm H2O for men and 38.0±20.0 cm H2O for women. The mean sniff nasal inspiratory pressure is significantly lower for women than for men. CONCLUION & CLINICAL SIGNIFICANCE The present study provides usefull normative data for assessing sniff nasal inspiratory pressure in ahmedabad population which may be used as an additive tool to measure inspiratory muscle strength. KEY WORDS sniff nasal inspiratory pressure, Inspiratory muscle strength, micro respiratory pressure measurement device. E-MAIL: [email protected]



ROLE OF PULMONARY REHABILITATION IN PATIENTS WITH

ADVANCED DESTROYED LUNG DISEASE DUE TO PULMONARY TUBERCULOSIS.

Dr. Manasi Shintre, Dr Nidhi Dixit,

Dr. S .G Gangal, (M.Sc , Ph .D , F .A. Sc, FNASc), Dr. Rohini Chowgule, (M.D , FCCP (USA) )

Indian Institute of Environmental Medicine

BACKGROUND: Although the benefit of pulmonary rehabilitation (PR) has been demonstrated for patients with Chronic Obstructive Pulmonary Diseases (COPD) , the benefit for patients with non- COPD lung disorders is still unclear . STUDY OBJECTIVES: In the present study, we studied the role of PR on patients with Advanced Destroyed Lungs (ADL) due to Tuberculosis (TB). METHODOLOGY: Study Design- A total of 21 patients with ADL coming to the Pulmonary and cardiac Rehabilitation centre at Indian institute of Environmental Medicine were enrolled in the study. The selected patients underwent a pulmonary programme for a period of 4 weeks. Sample Population-Of the 21 enrolled patients-16 were males and 5 females with an average age 51 +/- 5 years . Inclusion Criteria- Of the 21 patients enrolled in the study , only 8 patients who had completed their Anti-Koch’s Treatment (AKT) completed the programme for 4 weeks , were selected for the study. Exclusion Criteria- Of the remaining 13 patients not selected - 4 patients had not completed their AKT , 4 did not complete 4 weeks and 5 had other musculoskeletal problems . Sampling Method- Firstly, we noted the detailed history , physical examination , tested the subjects’ exercise tolerance using the 6-minute walking test and noted their perceived rate of exertion using Borg’s scale. Next , we trained the patients using a 4-week outpatient ( 45 mins , thrice a week) PR programme , which consisted of treadmill walking / cycling / stepping up and down –as cardio component , strengthening exercises using weights or therabands ( depending on their result of 1RM testing ) , breathing exercises and supplemental oxygen. We assessed the improvement using rate of perceived exertion on Borg’s Scale and 6-Minute walking test, after the 4 weeks of PR. Outcome Measure- 6MWT distance and rate of perceived exertion (RPE) on Borg’s Scale. Method of Data Collection and Statistical Analysis -The datas were collected retrospectively and analysed using Paired T Test. RESULTS: PR showed significant improvement in Borg Scale of exertion (11 ± 2 on day 0 to 9 ± 2 on day 30, p=0.029). However, 6MWT did not improve significantly in this period (427.13 ± 87.58 mts on Day 0 to 456 ± 104.13 mts on day 30, p=0.28). CONCLUSION: A month’s Pulmonary Rehabilitation can give significant relief and improvement in post-tuberculous advanced destroyed lung disease. Probably a longer PR will give significant improvements in 6MWT as well. KEY WORDS: Pulmonary Rehabilitation , Advanced Destroyed Lungs , Pulmonary Tuberculosis , 6 minute walk test. EMAIL: [email protected]


CARDIO-RESPIRATORY SECTION

DIGITAL PAPERS



COMPARATIVE STUDY OF POSTURAL DRAINAGE, OSCILLATING

POSITIVE EXPIRATORY PRESSURE (FLUTTER DEVICE) IN PATIENTS WITH AN ACUTE EXACERBATION OF CHRONIC BRONCHITIS

Dr.Smita U. Bankar

PDVVPF’S College of Physiotherapy, A.Nagar AIM: To compare the short-term effects of postural drainage & oscillating expiratory pressure in patients with an acute exacerbation of chronic bronchitis

OBJECTIVES- 1. To investigate the short-term effect of postural drainage in patients with an acute exacerbation of

chronic bronchitis

2. To investigate the short-term effect of Flutter in patients with an acute exacerbation of chronic

bronchitis

3. To compare the short-term effects of two techniques with regard to oxygen saturation, pulmonary

function and sputum production during an acute exacerbation of chronic bronchitis.

PURPOSE- Chest physiotherapy includes several techniques. One of these techniques involves a FLUTTER, Another technique is a POSTURALDRAINAGE which is widely used for many pulmonary disorders with increased production of sputum.The present study was undertaken to compare the short-term effect of two different techniques with regard to oxygen saturation, pulmonary function, and sputum production during an acute exacerbation of chronic bronchitis. METHODOLOGY Study design- A randomised controlled trial Sample population & size- 10 patients of acute exacerbation of chronicbronchitis Sampling technique- purposive sampling Inclusion criteria- Patients with a history & acute exacerbation of chronic bronchitis Exclusion criteria- Unconsicous & disoriented patient, Psychological imbalanced patient Outcome measures- Oxygen saturation (SPO2), Pulmonary function (FEV1), Sputum production (gm) Data collection & Analysis- Results are expressed as mean (SD). Data were analyzed through repeated-measures ANOVA. Within-treatment comparison measurements were assessed as averaging data and performing the t test for paired data. Differences were tested for significance at ex = .05. RESULT: There were no significant differences in SPO2 and FEV 1 during treatments and until 1 hour after either treatment. Sputum production increased significantly 30 minutes after the beginning of treatment with either technique: after flutter from 10.5g (6.2g) to 16.0g (9.6g), p< .01, after Postural Drainage from 9.6g (3.2g) to 16.5g (5.0g), p < .01. One hour after the end of treatments, sputum was increased from 16.0g (9.6g) to 20.0g (10.1g), p < .01, after Flutter; and from 16.5g (5.0g) to 18.5g (4.6g), not significant, after Postural drainage. Sputum recovery was similar with flutter and postural drainage. The repeated-measures ANOVA showed a non significant treatment-time interaction (p > 0.2), except for the factor time (p < .01). CONCLUSION: Both treatments techniques were safe and effective in removing secretions without causing undesirable effects on oxygen saturation, but FLUTTER was more effective in prolonging secretion removal than was the POSTURALDRAINAGE method KEY WORDS: Flutter; Postural drainage, Chronic bronchitis exacerbation; Sputum recovery EMAIL: [email protected]



EFFECTIVENESS OF BUTEYKO BREATHING IN HYPERTENSIVE SUBJECTS.

Ketaki Sant, Amita Mehta

P.T. School and Centre, Seth G.S. Medical College, Mumbai. AIM: To study the effectiveness of buteyko breathing in hypertensive subjects. OBJECTIVE: To find the effect of 4 weeks of buteyko breathing in stage 1 hypertension. METHODOLOGY: Study design-Prospective experimental, Sample population:30 stage 1 hypertensive subjects Sampling Method-Simple random Inclusion criteria: Stage 1 unmedicated hypertensive subjects Age group:40-55years Exclusion criteria: Any respiratory, neurological, hormonal and any other cardiovascular disorders. Outcome measures: Pre test systolic and diastolic blood pressure and post test measures were taken at the end of 1st,2nd,3rd and 4th week. Statistical Test: ANOVA test RESULTS: Pre test systolic blood pressure with Mean 143.33 and SD 4.04 reduced to Mean 137.53 and SD 4.25 at the end of 4th week (p<0.001). The pre test diastolic blood pressure with Mean 92.73 and SD 2.94 reduced to Mean 87.93 and SD 3.46 at end of 4th week (p<0.001). CONCLUSION- The results observed in the study showed that Buteyko breathing significantly reduces systolic and diastolic blood pressure in stage 1 hypertensive subjects. CLINICAL SIGNIFICANCE - Buteyko breathing exercise can thus be recommended as an effective intervention to reduce blood pressure in stage 1 hypertensive subjects. EMAIL: [email protected]



COMPARISON OF PEAK EXPIRATORY FLOW RATE (PEFR) BEFORE AND AFTER PHYSICAL EXERCISE IN OBESE AND

NON OBESE YOUNG INDIVIDUAL

Amruta Chavan S.B.B. College of Physiotherapy , Ahmedabad

AIM: To compare the peak expiratory flow rate (PEFR) before and after physical exercise in obese and non-obese young individual PURPOSE : Obesity has been associated with respiratory complications & it is believed to reduce lung volume. Obesity imposes additional stress on ventilation during exercise and may even result in pulmonary function impairment . The peak flow meter is an inexpensive device and can detect the early warning signs of a decrease in lung function. METHODOLOGY: Study design: experimental study Sample size: 30 subjects, 2 groups, 15 subjects in each group Sampling technique: simple random sampling Inclusion Criteria: healthy male & female, age 20 to 22 years, in obese (B.M.I: 18-24 kg/m2, B.M.I. ≥30kg/m²) Exclusion Criteria: history of smoking or alcoholism, any respiratory disease Outcome measure: peak expiratory flow rate (PEFR) Statistical analysis: t-test Data collection: 30 subjects were randomly selected according to bmi

group 1: BMI :18-24(normal range) group 2: BMI :≥30 (obese)

The procedure was explaind and written conset form was taken. height, weight, BMI,and physical status was determined before testing. An exprrimental study using the one group pretest-posttest design was performed on 15 obese and 15 non-obese young individual using a mini-wright peak flow meter to evaluate the PEFR before and after 6 minute of physical exercise. Unpaired t-test was used for data analysis using graph pad. Significance level was kept 5%. RESULT: PEFR was significantly reduced before & after physical exercise in non-obese young individual (t-2.15, p<0.05) & in obese young individual (t-3.09, p<0.05). After physical exercise PEFR was significantly reduced in obese than non-obese young individual (t-12.59, p<0.05). CONCLUSION: the PEFR of obese young individual was significantly reduced than non obese young individual before and after physical exercise. KEY WORDS: peak expiratory flow rate, obesity, physical exercise EMAIL: [email protected]



RESPIRATORY PROBLEMS OF ADULT WORKERS IN THE POWERPLANT IN GUJARAT

MAHARSHI TRIVEDI, DR. NEEPA TALATI, DR.NEETA VYAS

S.B.B. COLLEGE OF PHYSIOTHERAPY, AHMEDABAD

AIM: To know the respiratory problems of the power plant workers PURPOSE: In the power plant, workers are exposed to high temperature (above 55°c), fumes & gases and coal-dust in the surrounding air. The high temperature(above 55°c) affects the mucosa of the upper respiratory tract. This high temperature cause respiratory tract irritation. The coal-dust that is in the surrounding air of the power plant affects the lung tissues. There is accumulation of the particles in the lung and bronchioles. There is fibrosis of the lung tissue & obstructive and restrictive defect. Fumes and gases have smaller size then dust. They produce alveolar damage and destruction of respiratory epithelium. This study was undertaken to assess the pulmonary and respiratory problems of workers. METHODOLOGY: Study design: survey study Sample size : 100 subjects Sampling technique: simple random sampling Inclusion criteria: - workers of the power plant

- Age group (25 to 50 years) Exclusion criteria: - Recently joined workers (less than 6 month) - Workers with cardiac problems - Smoking Data collection: 100 subjects are randomly selected. All the workers are selected according to the inclusion criteria. The procedure is explained to them. Consent form is signed. A self administered Questionnaire is explained to them. Questionnaire is filled by the workers. Collected data was analysed. RESULT: 29 % of the workers are having respiratory problems. 79% of the workers in the power plant are having complained of chronic cough. 13% of the workers having complained of breathlessness. 8 % of the workers having sputum discoloration. CONCLUSION: The workers who are exposed to high temperatures, dusty environment and to the fumes and gases have more respiratory problems. As with increase in the duration of the work, the problems are increasing. Preventive measures need to be taken. KEYWORDS: power plant, coal dust, .mucosa, lung tissue.

EMAIL: [email protected]



COMPARISON OF LEISURE TIME HABITUAL PHYSICAL ACTIVITY LEVEL BETWEEN SMOKERS AND NON-

SMOKERS

VIKAS DHIMMAR M., DR. SWEETY SHAH S. B. B. COLLEGE OF PHYSIOTHERAPY, AHMEDABAD

PURPOSE OF THE STUDY: The aim of the study is to compare leisure time habitual physical activity level between smokers and non-smokers by using Baecke physical activity questionnaire. METHODOLOGY: STUDY DESIGN – comparative study SAMPLE SIZE – 30 normal individual who are smokers(Group-A) 30 normal individual who are non-smokers(Group-B) SAMPLING TECHNIQUE-random sampling technique INCLUSION CRITERIA-(it include normal healthy individual aged between 30 to 60 years) Group A - smokers Group B - non-smokers. EXCLUSION CRITERIA- Any pulmonary, cardiovascular, musculoskeletal, neurological disease. OUTCOME MEASURE – leisure index of the questionnaire of Baecke et al for measurement of a person’s habitual physical activity DATA COLLECTION – Subjects are divided into 2 groups. Subjects were explained the procedure and consent was taken. Subjects were asked questions as in the baecke questionnaire leisure index and the measurement was done by putting points in formula as in questionnaire. RESULTS-mean of the leisure index in smokers 2.058 and in non-smokers the mean is 2.558. the unpaired t-test is performed and it is significant. (P value=0.004). CONCLUSION-Individual with chronic smoking have reduced leisure time physical activity level then it is in non-smokers. KEY WORDS: leisure index of the questionnaire of Baecke et al for measurement, smokers, non-smokers. E-MAIL: [email protected]



COMPARISION OF VO2 MAX. OBTAINED FROM UKK WALK TEST AND ROCKPORT WALK TEST IN HEALTHY YOUNG SEDENTARY

INDIVIDUALS

Raunak Prajapati, Dr. Neepa Talati S.B.B College of physiotherapy, Ahmedabad

AIM: To compare the predicted vo2 max, obtained by comparing UKK walk test and Rockport walk test. OBJECTIVE: To check the accuracy of both the field tests in predicting vo2 max. PURPOSE OF STUDY: To use the UKK walk test as clinical assessment tool for predicting vo2 max. in the evaluation of cardio-respiratory fitness in normal individuals. METHODOLOGY STUDY DESIGN: Experimental study STUDY POPULATION: Healthy young sedentary individuals SAMPLE SIZE: 20 SAMPLING TECHNIQUE: Random sampling INCLUSION CRITERIA: Age: 20-40 years, Sex: both sexes, BMI: <25 EXCLUSION CRITERIA: Smokers, Overweight or Obese, Evidence of Cardio-respiratory disease OUTCOME MEASURES: 1. Vo2 max and time taken to walk 2. Heart rate 3. body mass index (BMI) DATA COLLECTION Twenty healthy untrained volunteers were been selected and their demographic data in the form of age, height and weight was taken. Subjects were divided in two groups. Group A and Group B were Group A includes Males and Group B includes females. The test was performed after having done some warming up exercises and some stretching. UKK Walk Test was performed by walking 2 km/1.24 miles as fast as possible at 80% of maximal heart rate by using karvonen’s formula on a level ground surface for both the groups and Rockport walk test was performed by walking comfortably for 1.6km/1 mile on a level ground surface for both the groups. Time taken to walk and the heart rate at the end of the test were been measured and vo2 max was calculated. DATA ANALYSIS Paired parametric T test was selected after normalization of the data. RESULTS Paired t-test was performed within the group with UKK walk test and Rockport walk test results were compared by paired t test within the groups, Where p value is <0.0001 which shows high significance of the study results. t- value obtained in the study is t=21 for female group and t=18.70 for male group. CONCLUSION Ukk walk test is an accurate measure to predict the vo2 max than the Rockport walk test and can be used as an clinical measurement tool to predict the vo2 max in the evaluation of cardio-respiratory fitness in normal healthy individuals. KEY WORDS: UKK walk test, Rockport walk test, level ground surface, vo2 max., heart rate, time, karvonen’s formula EMAIL ID: [email protected]



CORRELATION BETWEEN BREATH HOLDING TIME AND MAXIMUM VOLUNTARY VENTILLATION IN NORMAL

HEALTHY YOUNG ADULTS.

Jaini Jayendrabhai Patel, Dr. Neepa Talati S.B.B. College of Physiotherapy, V.S.Hospital, Ahmedabad, Gujarat.

AIMS & OBJECTIVES: To find correlation between breath holding time & maximum voluntary ventilation. PURPOSE: Maximum voluntary ventilation is a measure of respiratory muscle endurance and important criteria for weaning or putting patient on mechanical ventilator. (Chang). Breath holding time commonly used method as a measure of oxygenation & ventilation. But correlation between the two is yet unclear.(M.J. Parkes, Ex physiology, 91.1:1-15). So the study is conducted to find correlation between the breath holding time and maximum voluntary ventilation. METHODOLOGY: Study type: correlational survey Sample size: 35 Inclusion criteria: Age group between 20 to 35 years Exclusion criteria: Person having any respiratory disorder, Any musculoskeletal disorder involving respiratory muscles Method:

• 35 subjects were selected randomly from the campus of S.B.B. college of physiotherapy.

• The person was asked to hold the breath after deep inspiration till mild discomfort is felt by pinching the nose. The time was recorded in seconds by stopwatch. Three trials were taken and the best was selected.

• Maximum voluntary ventilation of the same person was taken with break of at least 5mins to allow respiration to settle at resting level.

• Maximum voluntary ventilation(Litres per minute) of 1 minute was taken by asking the person to respire as fast & as deep as possible for 15 seconds & the value was multiplied by 4. It was taken in Helios PFT machine.

• All statistical analysis done with use of Graphpad prism windows version 5.02.

RESULTS: The value of r between the two groups was 0.6767 which is significant at 95% confidence interval. P value found was <0.0001 with R square value of 0.4580. There is positive correlation between maximum voluntary ventilation and breath holding time. CONCLUSION & CLINICAL SIGNIFICANCE: Maximum voluntary ventilation is positively correlated with breath holding time that is statistically significant at α level 0.05. So breath holding time can serve as competent clinical tool that can substitute maximum voluntary ventilation measurement and is of value while deciding patient’s need for mechanical ventilation. EMAIL ID- [email protected]



PROTOCOL BASED CHEST PHYSIOTHERAPY IN POSTOPERATIVE HEAD & NECK CANCER PATIENTS IMPROVES EARLY

RECOVERY AND QUALITY OF LIFE: A PROSPECTIVE STUDY

NIRMAL KUMAR, SHIV PRATAP SINGH RANA, SEEMA MSHRA, SUSHMA BHATNAGAR

Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute Of Medical Sciences,

Ansari Nagar, New Delhi-110029.

INTRODUCTION: - Head and neck cancers represent a majority of malignancy in the world. In India, it is the major cause for increased morbidity and mortality. The three main types of treatment for managing head and neck cancer are radiation therapy, surgery and chemotherapy. Surgical interventions include extensive excisions, neck dissections and reconstruction with flaps. These patients are different from regular ICU patients such that they may have undergone chemotherapy and/ or radiotherapy or a major debilitating surgery and also have co-existent medical disease like diabetes, cardiac disease, COPD & hypertension. So management of these post operative patients in ICU is a challenging task. Pulmonary complications contribute to morbidity, mortality, and increased treatment costs as a result of prolonged hospitalization following major head and neck surgery. OBJECTIVES: - The role of the Physiotherapist is to assess each individual to identify their problems and to establish aims of treatment, thus devising an individual treatment plan. All the post operative head and neck cancer patients were assessed in ICU and treated daily until the patient discharged from the ICU to the ward. This prospective study was done to show the various physiotherapeutic procedures done in intensive care unit and their effectiveness on the patient’s condition as well as their duration of stay in ICU. MATERIAL AND METHOD:- This study included 110 patients who underwent major head and neck surgery, were monitored in the ICU and various physiotherapeutic procedures applied for early mobilization from Intensive care unit of Dr BRA Institute Rotary Cancer Hospital, AIIMS, New Delhi from October, 2009 to September, 2010. RESULTS:- 110 head and neck cancer patients admitted in ICU for post-operative care and observation. The patients ranged in age from 40 to 80 years, with a mean ± standard deviation (SD) of 58.8 ± 8.9 years. Out of 110 patients, 90 were male with strong history of chronic tobacco chewing (90%), smoking (80%), and alcohol consumption (60%) with age group of 22 – 80 years. There were 20 female with history of tobacco chewing in 12 patients and smoking in 15 patients, alcohol intake (occasionally) in 1 patients with age group of 24-60 years.70% patients required elective ventilatory support (SIMV/CPAP) followed by T-piece, then extubation after the nebulization, chest physiotherapy and thorough endotracheal and oral suction. Deep breathing exercise (DBE) was initiated approximately 30 minutes after extubation. Ultrasonic nebulization was given in 100% patients, steam inhalation in 80%, percussion, vibration, positioning, breathing techniques, relaxation techniques and coughing in 100% patients with expected results. ICU stay of patients varied from 24 hours to 48 hours CONCLUSIONS:- Protocol based physiotherapeutic interventions in postoperative head & neck cancer patients improves early ambulation and Quality of life. KEY WORDS: - Head and Neck Cancer Surgery, Intensive Care Unit, Chest Physiotherapy EMAIL: [email protected]



TITLE: PREVALENCE OF PRE-HYPERTENSION AMONG THE STUDENTS OF B.J.MEDICAL COLLEGE CAMPUS STUDENTS.

Zaiba Ekkiswala, Dr. Anjali Bhise

Govt. Physiotherapy College, Ahmedabad AIMS AND OBJECTIVES: To find the prevalence of pre-hypertension among B.J. Medical college campus students and to compare the body mass index, the occurrence of family history of hypertension and diet among the normotensives and prehypertensives. METHODOLOGY: STUDY DESIGN: Observational study. SAMPLE SIZE: 200. SAMPLING TECHNIQUE: Random sampling. INCLUSION CRITERIA: Students of B.J.M.C. campus within the age group of 17-24 years. EXCLUSION CRITERIA: Students with history of any chronic illness or drug intake known to influence blood pressure. OUTCOME MEASURE: Mercury sphygmomanometer. DATA COLLECTION AND ANALYSIS: Each student filled a questionnaire regarding age, sex,dietary habits,family history of hypertension. Height and weight of the subjects were measured to calculate their BMI. Blood pressure was measured by auscultatory method using standard mercury sphygmomanometer in sitting position. A mean of three readings was considered. Subjects found to be pre-hypertensive were checked for their blood pressure three times at weekly intervals. Students with diastolic blood pressure between 80-89 mmhg and systolic blood pressure between 120-139 mmhg were considered as pre-hypertensive. Inter-group comparisons were done by Mann Whitney U test. RESULTS: 28.5% of the subjects were found to be pre-hypertensive and 6% subjects were found to be hypertensive. The mean BMI of both groups differed significantly(P<0.0001). The mean blood pressures differed significantly with diet(P<0.0001) but did not differ significantly with family history(P=0.8322). CONCLUSION: Prevalence of Pre-hypertension was found to be 28.5% among the students. Students must be routinely screened for hypertension and greater emphasis on physical activity and diet modification should be given among these students. KEY WORDS: Blood pressure, pre-hypertension, prevalence. E-MAIL: [email protected].


ABSTRACT NO 158 (CARDIO 31)

STUDY THE EFFECTIVENESS OF PULMONARY REHABILITATION, USING 6 MINUTE WALK TEST, IN INDIAN

POPULATION, PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Dr. Nidhi Dixit, Dr. Nilesh Makwana ,

Dr. Rohini Chowgule, M.D , FCCP (USA) Dr. S .V. Gangal, (M.Sc , Ph .D , F .A. Sc, FNASc)

Indian Institute of Environmental Medicine

AIM: To study effectiveness of Pulmonary Rehabilitation (PR) in Indian patients with Chronic Obstructive Pulmonary Disease using 6 Minute Walk Test (6MWT). METHODOLOGY

• Study Design:-It is a Retrospective Cohort Study.

• Sample Population/Size:- A total of 37 COPD patients [M=32, F=5] (60.97 ± 7.91) attended our center for Rehabilitation in August – September 2010, Out of which 16 patients(13 Males and 3 Females) (65.2 ± 4.65)patients have successfully completed 6 weeks of Pulmonary Rehabilitation.

• Exclusion criterions:- Exclusion criterions were any conditions that would prevent them from undergoing a rehabilitation program (unstable angina, myocardial infarction, any orthopedic condition etc.) and those who do not have complete data.

• Sampling Methods/Technique:- BODE Score (BMI, Airflow obstruction, Dyspnoea index, Exercise Capacity) was used to classify these patients as per severity. The pulmonary rehabilitation program included Aerobic exercises (Treadmill / cycle or stepping up and down), strength training (Depending on their 1Repitition Maximum) and breathing exercises and supplemental oxygen. The rehabilitation program was administered thrice a week for 45 minutes for 6 weeks. Borg Scale (subjective perception by patient) & 6MWT (objective improvement in capacity) were measured at the beginning and after 6 weeks of this pulmonary rehabilitation program.

• Outcome Measures:- Those in most severe BODE Quartile (Q4) showed less improvement in 6MWT as compared to BODE Q3, Q2 & Q1 (p<0.01).

• Data Collection/Statistical Analysis:-The data were collected retrospectively. All the recorded data were then statistically analyzed using Paired T test.

RESULTS-- Those in most severe BODE Quartile (Q4) showed less improvement in 6MWT as compared to BODE Q3, Q2 & Q1 (p<0.01). However, Borg scale improvement in Q4 was comparable to those in Q3, Q2 and Q1 (p=0.31). CONCLUSION: This implies that starting PR earlier in the less severe stage of COPD will have a better effect on objective patient improvement as shown by 6MWT. Nonetheless, a 6 week PR in severe COPD atleast improves subjective perception of severity as shown by Borg Scale this study shows that pulmonary rehabilitation is beneficial as treatment modality in COPD even in early stages. KEY WORDS- Pulmonary Rehabilitation, Chronic Obstructive Pulmonary Disease, 6 minute walk test, BODE index. EMAIL ID : [email protected]


MUSCULOSKELETAL SECTION

PLATFORM PAPERS


ABSTRACT NO 8 (MSK 1)

A CO-RELATIVE STUDY BETWEEN THREE DIFFERENT CERVICAL SPINE POSTURES AND MANDIBULAR OPENING

IN NORMAL SUBJECTS.

Dr. Mona Pathania, Dr. Manish Arora, Dr. Ajay Arora SBSPGI, Balawala, Dehradun.

INTRODUCTION: Temporomandibular joint is affected with cervical spine postures. A correlation between the two has not been studied to a much extent till date and hence this study is an attempt to correlate the two. Some previous studies have proved that the group of patients with chronic forward head posture had more involvement of Temporomandibular joint as compare to the group without forward head posture. PURPOSE OF THE STUDY: To find out if there is any correlation between the different cervical spine postures and the mandibular opening in normal subjects with in age group of 18 to 28 years. METHODOLOGY: Design of the study: Co-relative design. Materials Used: Plumb line, tripod stand, digital camera, vernier callipers and image tool software. Subjects: 60 students (30 males and 30 females) with mean age of 22.5±2.884 years. Sampling technique: Stratified Random sampling method. Research Settings: Research Laboratory, Physiotherapy Department, SBSPGI, Balawala, Dehradun. Inclusion criteria: Age between 18 to 28 years, BMI between 18 to 23. Exclusion criteria: Presence of toothache, Loss of any incisor tooth, History of any trauma to neck or to temporomandibular joint. Variables: Mandibular opening & Craniovertebral Angle. PROCEDURE: Plumb line was used to define the neck positions. C-7 cervical spinous process and tragus of ear are marked using black temporary marker. Lateral photographs of subjects in three positions of cervical spine i.e. neutral, protracted and retracted were taken in sitting position on a chair with back straight. Camera was adjusted using tripod stand to maintain same height. Simultaneously in each position the maximum mouth opening is measured using vernier callipers. Three readings were taken for each position. Craniovertebral angle was measured using the Image Tool software. RESULTS: Karl-Pearson coefficient of correlation was found for the craniovertebral angle and vertical mouth opening in 180 positions of 60 subjects which claimed a moderate negative correlation between the two with r value of -0.479. CONCLUSION: Results showed a moderate negative correlation between the craniovertebral angle and mandibular opening i.e mandibular opening increased as the craniovertebal angle decreased and vice versa. CLINICAL SIGNIFICANCE: Temporomandibular joint should be assessed thoroughly while the assessing the cervical spine and vice versa, as a faulty cervical spine posture can influence the TMJ function. KEYWORDS: Mandibular opening, Craniovertebral angle, Vernier callipers. e-mail: EMAIL: [email protected]



CONCURRENT VALIDITY AND RELIABILITY OF ANEROID SPHYGMOMANOMETER FOR CRANIOCERVICAL FLEXION

TEST IN NORMAL INDIVIDUALS

Dr.Renu.V.Mahashabde, Dr.Shaila .M. Sabnis

Sancheti Institute College of Physiotherapy

INTRODUCTION: Research has established that patients with neck pain disorders display reduced isometric endurance of the deep cervical flexor muscles and show altered neuromotor control strategy during craniocervical flexion test. Craniocervical flexion test is performed in supine position using pressure biofeedback placed suboccipitally. Aneroid sphygmomanometer shows the same construction, working mechanics as pressure biofeedback. It has been used to check peripheral muscle strength but not for the deep neck flexors. AIM: To establish the concurrent validity and reliability of aneroid sphygmomanometer for craniocervical flexion test in normal individuals. OBJECTIVES: 1] To establish the concurrent validity of aneroid sphygmomanometer for craniocervical flexion test in normal individuals 2] To establish the intrarater reliability of aneroid sphygmomanometer for craniocervical flexion test in normal individuals 3] To establish the interrater reliability of aneroid sphygmomanometer for craniocervical flexion test in normal individuals METHOD: a) study design: observational b) sample population-normal volunteers of either sex, 100 separate group of volunteers for validity, intrarater and interrater reliability each. c) sampling method/technique which used for sample collection: chit method d) outcome measure – activation score measured in mm of Hg e) method of data collection – observational statistical test used for data analysis: validity - Pearson’s product moment correlation coefficient reliability - Intraclass correlation coefficient PROCEDURE: Inclusion criteria was asymptomatic individuals whereas those with neck pain currently or for >2weeks, neurodeficit, thoracic region pain or headaches in the preceding year were excluded. Subjects performed CCFT with pressure biofeedback and aneroid sphygmomanometer alternately with a rest of 15minutes to establish the validity. For interrater reliability, test was performed on the same day with rest of 15 minutes with 2 different raters. For intrarater reliability, the subjects performed the test thrice on 3 different days with a rest of 1 or 2 day interval in between. The highest pressure achieved and held for 10seconds was recorded .The data was statistically analysed . The validity and reliability was found out by Pearson’s product moment correlation coefficient and Intraclass correlation coefficient respectively. RESULTS: The data was statistically analysed .Concurrent validity of aneroid sphygmomanometer as per Pearson’s product moment correlation was (r= 0.856) for activation score. Intrarater reliability (ICC) was 0.79(0.72- 0.84) and interrater reliability was 0.77(0.67-0.84) CONCLUSION AND CLINICAL SIGNIFICANCE: The study concluded that aneroid sphygmomanometer shows good concurrent validity and good intrarater and interrater reliability for craniocervical flexion test in normal individuals. Thus, use of a device which is easily accessible, versatile and less costly can be suggested for performing the test in clinical settings. KEYWORDS: CCFT, reliability, validity, aneroid sphygmomanometer



EFFECTS OF NECK CORE STABILITY TRAINING AND CONVENTIONAL EXERCISES ON DEEP NECK FLEXORS

ENDURANCE IN COMPUTER PROFESSIONALS WITH CERVICAL STRAIN.

Dr Ravinder Kaur Marwaha, Dr Mrs Prof Sona Kolke


AIM: To study the effects of core stability exercises with conventional exercises on Deep neck flexors endurance in computer professionals with cervical strain OBJECTIVE: To compare the effects of core stability exercises with conventional exercises versus conventional exercises on computer professionals with cervical strain on pain, craniovertebral angle, cervical Range of motion, deep neck flexors endurance, and functional status. METHODOLOGY: Study Design: Randomised controlled trial Sample size & population: 40 computer professionals with mechanical neck pain. Sampling technique: Simple Random sampling. Inclusion criteria: Mechanical neck pain, Person working hours more than six hours, Duration of neck pain more than 2 months. Exclusion criteria: Cervical spondylosis, congenital anomalies, Subjects currently on medications, cervical myelopathy and unstable fractures Outcome measures: pain on VAS, craniovertebral (CV) angle by photograph, cervical range of motion(ROM), deep neck flexors endurance by modified pressure bio feedback unit(PBU) and functional outcome by Neck Disability Index. Data collection & analysis: Subjects were randomly allocated into experimental and control groups. Control group received conventional exercises viz-scapular setting, self-neck stretches, ergonomic advices and hot fomentation. The experimental group received neck core-training and conventional exercises. Data analysed at baseline, 30 days, and after 2month of follow-up with paired & unpaired t test; Wilcoxon’s signed rank test & Mannwhitney U test. RESULTS: At 30 days, both groups showed significant improvement in pain, within group (p<0.05) but experimental group showed more improvement (2.45+1.19). Core muscles showed high improvement in experimental group (p <0.05) (8.8+ 1.98), CV angle was improved in both groups but significantly higher in experimental group (p<0.05) (46.3+ 5.34). Both groups showed significant improvement in all cervical range of motion but experimental group showed more improvement (p<0.05). Disability index showed significant improvement in both groups, but experimental showed more improvement (p<0.05) (7.25+4.2) (U= 30.5). At 2-month follow-up, both groups showed significant improvement in cervical range, CV angle, and disability index, within group. But experimental showed more improvement in neck ROM (p<0.05), neck disability index (U=15.5), CV angle (50.9+5.47), Core muscles endurance was improved in experimental group (p<0.05) (9.5+1.53). Pain was improved in experimental group only (p<0.05) (0.25+0.57). CONCLUSION: neck core muscle training along with conventional exercises is more beneficial in treating mechanical neck pain. CLINICAL SIGNIFICANCE: neck core training should be included with conventional treatment for correcting posture & reducing incidence of cervical strain & early cervical spondylosis. KEYWORDS: cervical strain, neck core. EMAIL: [email protected]



MANIPULATION OF THE WRIST FOR MANAGEMENT OF LATERAL EPICONDYLALGIA

Matharu HK, Khatri SM, Sumbh

College Of Physiotherapy, Pravara Institute of Medical Sciences (PIMS), Loni. AIM: To compare the effectiveness (1) Manipulation of the wrist and conventional treatment (2) Conventional treatment protocol. PURPOSE: Tennis elbow may be caused by displaced motion segment of wrist and not enough literature is there for manipulation of wrist in lateral epicondylalgia, so the purpose was to study the effectiveness of manipulation of wrist in tennis elbow. METHODOLOGY: Study design- Randomized Clinical Trial. Sample population & size: Forty-five subjects with examination results consistent with lateral epicondylalgia participated in the study. Sampling technique: Simple randomization. Inclusion criteria: diagnosed with lateral epicondylalgia. Exclusion criteria: no limitation in range of motion, bilateral complaints, severe neck or shoulder problems likely to cause or maintain the elbow complaints Data collection & analysis -Subjects were randomly assigned to either a group that received Manipulation of wrist in addition to conventional treatment (group 1) group that received conventional treatment (group 2). Follow-up was at 3 and 6 weeks. Analysis was performed using independent t-test and Mann Whitney U test. Outcome measure: Global measure of improvement scale, Numerical pain rating scale. RESULTS: Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD_2.4) in group 1, as compared with3.2 (SD_2.1) in group 2 CONCLUSION: Manipulation of the wrist is effective in reducing the symptoms of patients with tennis elbow and can be considered as an adjunct to conventional physiotherapy for the management of lateral epicondylalgia. CLINICAL SIGNIFICANCE: manipulation of wrist should be considered a treatment option in lateral epicondylalgia. KEY WORDS: manipulation, wrist, lateral epicondylalgia, treatment. EMAIL: [email protected]



COMPARISON OF BILATERAL WITHIN SUBJECT QUADRICEPS ANGLE (Q-ANGLE) IN ASYMPTOMATIC

YOUNG ADULTS.

Dr. PrakrutiMotka, Dr.M.Balaganpathi

Charotar Institute of Physiotherapy, Changa, Gujarat

AIM:Q-angle is very important index of patellofemoral function &dysfunction. So this study was designed to compare Q-angle in asymptomatic young adults. OBJECTIVE: To know whether there is any difference in right & left Q-angle. Study design: Cross sectional study Sample population:60 Healthy subjects (39 females & 21 males), age between 15-30years from Charotar University of science and technology were selected for the study. Sampling method: Simple random sampling. Outcome measures:Right & left Q-angle Materials: Universal Goniometer, Water soluble marker, Meter rule, Spirit & Cotton METHODOLOGY: Subjects were selected for the study, after checking for the inclusion and exclusion criteria. The right and left Q-angles were goniometrically measured while they adopted a static standing position with quadriceps relaxed. RESULTS: Paired t- test was done using graph pad software for data analysis. The result showed that the Q- angles for right & left lower limb were 16±2.316 & 16.625±2.623 respectively. Analysis showed a significant difference in Q-angle (P= 0.0127, P<0.05) with left limb having higher values compared with right limb. CONCLUSION & CLINICAL SIGNIFICANCE: As the right limb is dominant in all the subjects, the randomized trial has shown that left Q-angle is significantly higher than right Q-angle.so degree of asymmetry needs to be considered while measuring Q-angle. KEY WORDS: Q-angle, Knee joint, Goniometer EMAIL: [email protected]



ROLE OF PHYSIOTHERAPY IN PREVENTING SECONDARY PLANTAR CALLOSITIES IN RHEUMATOID FEET

Mrs. Meenal Kotkar 1, Dr. Kaushik Bhojani 2

1: Department of Physiotherapy, Magnum Hospital and Research Centre, Nasik

2 : Rheumatologist, Fortis Hospitals, Mumbai BACKGROUND: In patients of Rheumatoid Arthritis, secondary problems arise due to foot deformities – and 66 % develop Painful plantar callosities which cause severe pain, disability and affect the patient’s functional capacity adversely. OBJECTIVE: To determine the role of physiotherapy in Rheumatoid arthritis patients with early foot involvement - in preventing secondary plantar callosities. METHODOLOGY: 42 patients (both sexes.), age 20years-55years, onset 1 -5 years, were included. Sero negative spondyloarthropathies, acute stage- Synovitis, patients with severe Knee and /or Hip deformities were excluded. Patients with correctable foot deformities with and without early signs of plantar hyperkeratosis were divided into 2 groups, Group A and Group B. Group A: Patients underwent adequate exercise and Rehabilitation program and given corrective Orthosis (n= 36 feet, 18 patients) Group B: Patients given corrective Orthosis alone. (34 feet, 17 patients) Patients called regularly for 15 days, follow-ups conducted after 1 month, at 6 months. Their compliance to exercises and orthosis was monitored, Patient’s detailed assessment sheet, written Consent for Study, Foot Functional Index questionnaire was given. Foot impressions were taken to analyze the foot deformities and excessive pressure points. Gait analysis was done in detail. RESULTS: Group A: Of the 18 patients, 13 patients (26 feet), showed marked improvement in foot function, softening of the plantar skin beneath the Meta- tarso phalangeal joints, reduction in pain, with no increase in pain /disability. No new locations of any hyper keratotic skin, on the plantar aspect or any callosity formation were seen. Group B: Of the 17 patients / 34 feet, only14 feet showed softening of the plantar skin beneath the Meta tarso phalangeal joints, and reduction in pain. The other patients showed only passive correction of their foot deformities with corrective Orthosis, but no changes in the plantar skin texture. They complained of pain under the forefoot and an Antalgic Gait after walking a distance without the Orthosis.These patients are more prone to develop plantar callosities sooner or later. Group A :72 % of the patients showed improvement Group B: 41 % of the patients showed improvement Standard error in difference of proportion of recovery in 2 groups is 0.1808. CONCLUSIONS: At significance level of 0.10, the difference in recovery of 2 groups A and B is statistically significant. This study revealed that corrective orthosis were not enough to prevent secondary planter callosities in the rheumatoid feet and that Physiotherapy is more vital together with orthosis. KEY WORDS: Plantar callosities, foot deformities in Rheumatoid arthritis patients, physiotherapy and rehabilitation; corrective orthosis. E-MAIL: [email protected]



CORRELATION AND REGRESSION AMONG PAIN, PHYSICAL STRENGTH, FUNCTIONAL ABILITY, QUALITY OF LIFE AND

SEXUAL FREQUENCY IN LOW BACK PAIN

Dr Suraj Kumar, Anoop Aggarwal. Pandit Deen Dayal Upadhyay Institute for the Physically Handicapped, New Delhi.

AIMS: The present study was undertaken to find out the relationship among outcome variable as well as association between dependent variables with physical characteristics. OBJECTIVE:- Correlations between outcome variables [pain, back pressure change-BPC, abdominal pressure changes-APC, walking, stairs climbing, stand ups, quality of life (QOL) and sexual frequency] of all LBP subjects before and after treatments. Regression analysis estimate baseline BPC and APC of LBP subjects from their baseline demographic characteristics (age, height, Waist circumference, Systolic Blood pressure, Pulse rate) and severity of Pain. METHOD: Study design:- Randomised controlled trial Sample population- 141 Non specific low back pain Sampling method- After baseline recording, all subjects were given trunk stabilization training for 20 regular days. After training, the follow up was done at gap of each 15 days up to 6 months (180 days). Outcome measure – The level of pain intensity was assessed by visual analogue scale, Physical Strength were (BPC and APC) measured by Pressure measuring device, functional ability (Walking, Stair climbing and Stand up) was assessed according to Waddle functional evaluation test, and Quality of life measured by using SF-36 questionnaire. PROCEDURE: -Total 141 non-specific chronic low back pain patients were recruited. After baseline recording, all subjects were given trunk stabilization training for 20 regular days. After training, the follow up was done at gap of each 15 days up to 6 months (180 days). At the last follow up session (180th day) the outcome variables were recorded again. Data collection and data analysis- Statistical analysis was done using Spearman rank order correlation analysis and step wise multiple regression analysis. Spearman rank order correlation was used separately to assess relative association among outcome variables before and after the treatments. Step wise multiple regression analysis (forward and backward elimination) was done to identify significant predictors of baseline back and abdominal pressure changes, from their baseline physical characteristics and pain severity considering back and abdominal pressure changes as dependent variable and pain and physical characteristics as independent variables. RESULTS: This present study found an inverse relation between pain and muscle functions (BPC: r= -0.36; P<0.01and APC: r= -0.26; P<0.01). This study also showed that BPC was more inversely related with the pain than APC. CLINICAL SIGNIFICANCE: This study concludes that Physical strength (BPC & APC) of LBP subjects is more closely associated with the pain than the functional ability (Walking, Stairs climbing and Stand-ups). This study also estimated (baseline or before treatment) BPC and APC in LBP subjects from their physical characteristics and pain severity. KEY WORDS: Low Back pain, Correlation, Rehabilitation, Regression E-MAIL : [email protected]



INTER AND INTRA-RATER RELIABILITY OF THE CRANIOCERVICAL FLEXION TEST BY USING MODIFIED SPHYGMOMANOMETER AS A

PRESSURE BIO-FEEDBACK

Harshit Soni(PT) Sushant Dey(PT), Nishant Tejwani(PT), Dharti Hingrajia(PT), South Gujarat Medical Education And Research Center

Surat People’s Bank Physiotherapy College, Surat

AIM AND OBJECTIVES AND PURPOSE OF THE STUDY: The Cranio-Cervical Flexion Test (CCFT) is a clinical test to measure the endurance of the Deep Cranio-Cervical Flexors (DCCF) muscles, the longus colli and longus capitus. The endurance of these muscles is measured as an Activation Score (AS) and Performance Index (PI) via this test. This test is carried out by using Chattanooga Pressure Biofeedback unit (CPBU) which shows excellent intra-rater reliability. In India, we use modified sphygmomanometer instead of CPBU, but the data on reliability of the instrument is scarce. So present study was carried out to check inter and intra-rater reliability of the CCFT by using modified sphygmomanometer. METHODOLOGY: Study Design : Correlational Sample Population and Sample Size: 50 male (n=20) and female (n=30) subjects were selected from the age group of 17 to 22 (Mean age 19.86) years. Sampling Technique : Selective Inclusion Criteria: Subjects with no history of neck pain within the age group of 17 to 22 years. Exclusion Criteria: Subjects with any history of neck pain, with history of any surgery in and around cervical spine, performing regular exercises of the neck muscles Outcome Measure : AS and PI Data Collection: For inter-rater reliability the AS and PI were measured on each subject by two different experienced Physiotherapists. For intra-rater reliability the same was measured on two occasions with 7 days gap by the same therapist. Data Analysis: Two-tailed Intra-class Correlation Coefficient (ICC-Pearson) was calculated by SPSS13.0 version to check inter and intra-rater reliability at 0.01 level of significance for AS and PI. RESULT: For AS mean±SD were 8.32±1.86 and 8.44±1.86 and for PI mean±SD were 65.68±17.22 and 58.00±18.74 measured by two different raters respectively which showed good inter-rater reliability determined by the ICC= 0.709 and 0.752 respectively. For AS mean±SD were 8.44±1.86 and 8.24±1.74 and for PI mean±SD were 58.00±18.74 and 59.88±18.44 measured by the same rater on two occasions with 7 days gap, which showed excellent intra-rater reliability determined by the ICC=0.820 and 0.885 respectively. CONCLUSION: The CCFT by using modified sphygmomanometer showed good inter-rater and excellent intra-rater reliability. CLINICAL SIGNIFICANCE: On the basis of present study we proved that the modified sphygmomanometer can be used as a pressure bio-feedback instead of CPBU in CCFT as it is cost effective and easily available for Indian Physiotherapist. KEY WORDS: Cranio-Cervical Flexion Test, Modified Sphygmomanometer, Deep Cranio-Cervical Flexors, Reliability E-Mail: [email protected]



A STUDY TO CORRELATE POSTURAL THORACIC KYPHOSIS AND ABDOMINAL MUSCLE STRENGTH AND ENDURANCE

Rati. P. Ghumare, Dr. Mrs. Bharati Asgaonkar

College of Physiotherapy, Topiwala National Medical College, B.Y.L.Nair Hospital, Mumbai Central, Mumbai 400008

AIM AND OBJECTIVES: To find the correlation between kyphotic index and abdominal muscle strength and endurance using manual muscle testing and pressure biofeedback methods, in kyphotic individuals and individuals with ideal posture. PURPOSE OF STUDY: During prolonged stooped postures at work, particularly in slouched sitting the distance between the rib cage and the pelvis reduces and the abdominal muscles are put into a biomechanically altered position thus leading to altered length tension relationship of these muscles. This study has been attempted to find whether this altered length tension relationship is significant enough to show a clinically measurable change in abdominal muscle strength and endurance. METHODOLOGY: Study design: Non interventional analytical Study location: Physiotherapy OPD of tertiary care hospital Study duration: 1year Subjects sampled: Sample size – 60, Age group: - 20 to 50 Yrs Screened using plumb line assessment method in lateral view and divided into Group A: - 30 individuals with postural thoracic kyphosis, Group B: - 30 individuals with ideal plumb line alignment. Inclusion criteria: Individuals with postural thoracic kyphosis, Those willing to participate. Exclusion criteria: Koch’s spine, Fracture of spine, Acute prolapsed intervertebral disc, Any neurological deficit, Scoliosis, Individuals engaged in any kind of sports activities or physical training. Assessment parameters: 1. Posture: a) Plumb line assessment b) Kyphotic index using Flexi curve assessment 2. Manual muscle testing: - Lacote’s method (Grades 1 to 5) 3. Prone pressure biofeedback for strength and endurance 4. Posterior pelvic tilt using pressure cuff, for strength and endurance 5. Number of curl ups in one minute. Data analysis: The data was statistically analyzed using Pearson’s correlation coefficient RESULTS: The results showed no statistically significant correlation between strength of abdominal muscles and kyphotic index (r = 0.05 to 0.27) and endurance of abdominal muscles and kyphotic index (r = 0.03 to 0.26) in either of the groups. CONCLUSION & CLINICAL SIGNIFICANCE: With increase in postural thoracic kyphosis, there is no significant difference in the strength and endurance of rectus abdominis, obliques internus and externus, transversus abdominis muscles. KEY WORDS: - Postural thoracic kyphosis, Kyphotic index, Abdominal muscles E-MAIL ADDRESS: [email protected]



PREVALENCE OF PIRIFORMIS SYNDROME IN INDIVIDUALS WITH SEDENTARY LIFE STYLE

E.S.Cheraladhan

KJ Pandya College of Physiotherapy, Sumandeep University, Vadodara, Gujarat.

INTRODUCTION Piriformis syndrome is considered an entrapment neuropathy caused by pressure on the sciatic nerve by an enlarged or inflamed piriformis muscle against the bony pelvis and is often termed as “Pseudosciatica”. The term “Piriformis Syndrome” was coined by Robinson in 1947. Risk factors for Sciatica / Pseudosciatica include trauma, unaccustomed activity, age (degenerative changes can aggravate minor trauma), smoking, obesity, vibration (e.g. driving a car), sedentary lifestyle and psychosocial factors. OBJECTIVES

• To determine the association between piriformis syndrome and sedentary life style.

• To evaluate the extent of magnitude of piriformis syndrome in subject with sedentary life style diagnosed for sciatica.

• To establish H reflex latency in diagnosing piriformis syndrome in a rehabilitative set up.

METHODOLOGY Study design - Correlative cross sectional survey Study setting - K J Pandya College of Physiotherapy, Dhiraj General Hospital, Physiotherapy OPD, Vadodara Sample population- Individuals with sedentary life style clinically diagnosed for sciatica based on International Epidemiological Association criteria. Sampling method - purposive sampling Outcome measure – Electrophysiological study-H Reflex Method of data collection – H-reflex testing was done by Neuro physician having more than 5 years of clinical experience. DATA ANALYSIS & RESULTS Total 100 subjects participated in the study and 87 have completed the study in which 10 were diagnosed as cases of piriformis syndrome. Mean, Standard Deviation and Percentage values were calculated by using SPSS-17. The mean ± SD for H-reflex is 33.12 ± 4.37. Thus the study shows that 11.49 % of the subjects with sedentary lifestyle had sciatic pain due to piriformis muscle involvement. The above mentioned percentage is higher than the average of 6-8 % prevalence of piriformis syndrome in patients of sciatica in general. CONCLUSION The study suggests that large number of sedentary individuals suffering from sciatic pain may have the pain due to involvement of the piriformis muscle. The results of the study conclude that there is a significant association between piriformis syndrome and individuals with sedentary life style. So subjects with sciatica leading sedentary life style need to be addressed for piriformis syndrome. EMAIL: [email protected]



EFFECT OF MYOFASCIAL TRIGGER POINT RELEASE IN PATIENTS WITH FROZEN SHOULDER

Dr.Riddhi Vasani, Prof. .Rajashree Naik

P.T School & Centre Seth G.S.M.C (K.E.M. Hospital Mumbai)

AIM AND OBJECTIVES To study the effect of myofascial trigger point release on pain intensity, range of motion and functional outcome in patients with frozen shoulder METHODOLOGY Study design – Prospective comparative design Sample size – 75 Sampling method – simple random. Patients randomly divided into 3 groups Group 1 – 25, Trigger point release Group 2 – 25, Trigger point release and Joint mobilization Group 3 – 25, Joint mobilization Treatment was given 6 days/week for 2 weeks. Inclusion Criteria-75 patients of frozen shoulder having unilateral involvement with atleast one or more trigger points in subscapularis, supraspinatus, infraspinatus or deltoid.Pain on activity on VAS > 5.Duration of at least 1 month. Exclusion Criteria - Any other musculoskeletal complaints, Uncontrolled diabetes mellitus, neurological, medical condition. Outcome Measures - Site of pain, Glenohumeral range of motion, Pain intensity using VAS scale, Disabilities of arm, shoulder and hand DATA COLLECTION AND ANALYSIS Site of refered pain – chi- square, pain intensity, pain on compression of trigger point on VAS Scale, range of motion, DASH score - Wilcoxon Signed Ranked Test, Kruskal Wallis Test $ Dunn’s Multiple comparison. CONCLUSION $ CLINICAL SIGNIFICANCE Myofascial trigger point release and combination of myofascial trigger point release and joint mobilization is more effective than joint mobilization alone in improving pain, range and function in patients with frozen shoulder. RESULTS There was statistically significant improvement in pain at rest , on activity, night pain ,referred pain, DASH in group 1 and group 2 compared to group 3 with non- significant difference between group 1 and 2 There was statistically significant improvement in flexion,extension, abduction,IR,ER range of motion and in group 1 and 2 compared to group 3 with no difference between group 1 and 2. KEY WORDS – frozen shoulder, trigger point, myofascial release

EMAIL ID - [email protected]



EFFECT OF WEIGHT BEARING REHABILITATION PROGRAMME IN PATIENTS DIAGNOSED WITH

PATELLOFEMORAL PAIN

Aditya Dandekar, Dr G. J. Ramteke

Ravi Nair Physiotherapy College, Sawangi Meghe, Wardha AIM- To study the effect of weight bearing rehabilitation programme in patient diagnosed with Patellofemoral pain. OBJECTIVES- 1. To create awareness about the Patellofemoral pain and disability. 2. To encourage weight bearing activities. PURPOSE OF THE STUDY- To examine the usefulness of the specific exercises (Physiotherapy exercise programme) for patients with Patellofemoral pain by comparing the specific rehabilitation programme with general programme. METHODOLOGY- Study Design- Interventional. Sample size- 50 patients diagnosed as Patellofemoral pain. Sampling Technique- simple random sampling. Inclusion Criteria- 1. Subjects having history of anterior, retro or peripatellar pain that was readily reproducible during atleast 2 of following activities within last one month: Ascending and descending stairs, Hopping and running, Squatting, Prolonged sitting 2. Insidious onset of symptoms related to trauma.. Pain on palpation of patellar facet. 4. Both gender with Age between 20-50 years. Exclusion Criteria- History of ligamentous pathology around knee, History of patellar tendinitis, History of joint effusion, History of knee surgery, History of patellar subluxation or dislocation, Significant injury affecting other lower extremity joint, Patients with evidence of tibiofemoral osteoarthritis. Outcome Measures-

- Primary outcome measure was visual analogue scale based on self reported Pain (0-10).

- Secondary outcome measure was Patellofemoral joint evaluation scale for evaluation of disability or functional improvement.

Data Analysis- Data was collected according to assessment proforma and was analyzed using various statistical measures such as mean, standard deviation and test of significance such as unpaired ‘t’ test and Mann- Whitney test were utilised. RESULT- Result of present study showed the weight bearing rehabilitation programme along with conventional treatment were superior than conventional treatment alone in treatment of Patellofemoral pain in term of increasing range of motion (Flexion 0-120±10, extension120-0 ±5), decrease in pain (Mean score 2.35±1.5) and improvement in functional activities(90-100 points = excellent sore). CONCLUSION- simple random study found that the weight bearing rehabilitation programme along with conventional treatment effective in treatment of Patellofemoral pain and hence clinically can be used effectively in combination with routine physiotherapy for treatment of Patellofemoral pain. KEYWORDS- Patella, femoral, pain, weight bearing, rehabilitation, programme. EMAIL- [email protected]



EARLY EXERCISE REHABILITATION AFTER FIRST TIME

OPERATED LUMBAR DISCECOMY

Dr Rajendra Modiya,1 Dr Bharat R Dave2 1: SBB college of Physiotherapy Ahmedabad, Gujarat.

2: Stavya Spine Hospital and Research Institute (SSHRI) TM AIM : To see the effectiveness of incorporation of core stability program in early stage of rehabilitation in Lumbar discectomy. OBJECTIVE: To assess the effectiveness of early regimen of core stability exercise compared with an ordinary care program after 4 weeks. METHOD a) study design: A randomised control clinical trial(RCT) b) sample population- Indian population 124 patients operated at SSHRI c) sampling method/technique which u used for sample collection: RCT d) outcome measure – VAS, ODI e) method of data collection and statistical test used for data analysis: The patient operated at SSHRI ahmedabad from Oct 2009 to Sep 2010 were consecutively randomised for the training group (core stability regimen) and the control group (Isometric and lower lumbar flexion exercise after 4 weeks). The age group of 25-40 years both male and female operated first time at SSHRI at level L4-5 and L5-S1 included. Patient having traumatic PIVD, cauda equine syndrome , recurrent PIVD, degenerative disc disease excluded. Both groups has received advised for the back care to be continuing ADL. The outcome measures evaluated after 4, 8, 12 and 24, weeks after exercise. The results are based on intension to treatment analysis about effectiveness of early exercise program helping in resume the job and activity of daily living. RESULTS

Kruskal-Wallis test P value < 0.0001 Exact or approximate P value? Gaussian Approximation P value summary *** Do the medians vary significantly. (P < 0.05) Yes Number of groups 4 Kruskal-Wallis statistic 467.3 CLINICAL SIGNIFICANCE. Early exercise rehabilitation core stabilization program dose help in early resume in activity of daily living and back to work compare to regular exercise program after 4 weeks. KEY WORDS: Early exercise, first time Lumbar Discectomy, Indian population, core stability E-MAIL: [email protected]



STUDY OF RATIO OF STRENGH OF QUADRICEPS AND HAMSTRINGS MUSCLES IN PERSONS WITH MODERATE KNEE

PAIN

Azharuddin M. Shaikh, Dr.Megha Sheth, Dr.Neeta Vyas

S.B.B.College of Physiotherapy,V.S.Hospital,Ahmedabad.

AIM OF STUDY: The relationship between strength and length of muscles around a joint is ‘muscle balance’(1).There are multiple muscles around a joint but relationship of agonist and antagonist is important for balance(1).Quadriceps and hamstring are two important muscles acting on knee joint and has great importance in stability and movement of knee joint(1).Normal ratio is important to prevent injury as well as developing O.A. of knee later on(1).Reported value for ratio of Quadriceps and hamstring strength at slow isokinetic speeds is 3:2 OR 1.5 in non-sports persons(1). OBJECTIVE OF THE STUDY: To study strength ratio of Quadriceps and Hamstrings muscles in persons having moderate knee pain. METHODOLOGY: a) Study design :- cross-sectional study b) Sample population and sample size:-50 persons coming to OPD of S.B.B. college of physiotherapy, V.S.Hospital. c) Sampling technique:- simple random sampling d) Inclusion criteria:- 25subjects -40-60 years of age having moderate knee pain since 3 months for experimental group. 25Age appropriate subjects without knee pain for control group Exclusion criteria:- H/o recent trauma, H/o any recent surgery (within 1 year ) of knee joint, H/o physiotherapy taken in last 1 month, Athletes e) Outcome measures:- 1 RM f) Data collection and analysis: 50 persons were selected from which 25 persons referred from V.S. orthopaedic OPD with moderate knee pain(group A) and falling in inclusion and exclusion criteria and 25 persons without knee pain coming to OPD for other problems (Group B) were selected for study. Procedure was explained to the patients and written informed consent was taken. 1 RM of Quadriceps and Hamstrings was found out by 3 trials on 3 days and average was recorded. Data collected was analysed using unpaired t-test. Level of significance was kept at 5 %. RESULTS: Mean of group A was found to be : 40.06±4.777 Mean of group B was found to be: 23.53±4.036 Difference between means of both groups was found to be statistically significant at t=2.632 and p≤0.05 CONCLUSION AND CLINICAL SIGNIFICANCE: Q:H ratio is significantly decreased in subjects with OA knee. There is a need to work on improving strength of quadriceps muscles in subjects with OA knee. KEY WORDS: 1RM, quadriceps and hamstrings strength ratio, O.A. knee E MAIL: [email protected]



COMPARISION OF RESPONSIVENESS &CLINICAL UILITY OF THREE OUTCOME MEASURES IN MILD TO MODRATE

OSTEOARTHRITIS KNEE PATIENTS UNDERGOING PHYSIOTHERAPY INTERVENTION

Mrs. Sarita Kothari, Mrs. Bharati Asgaonkar

T. N. Medical College & B. Y. L. Nair Hospital, Mumbai. PURPOSE: To assess even smallest effect of rehabilitation intervention, we need highly responsive outcome measure. Ultimate value of any outcome measure is it’s clinical utility .Purpose of study is to find responsiveness outcome measure with more clinical utility to asses osteoarthritis knee. AIM AND OBJECTIVE: To find and compare responsiveness and clinical utility among WOMAC, KOOS, Lequesne’s index to assess patients having mild to modrate osteoarthritis knee (grade 2-3 Kellgren-Lawrence radiological grading) undergoing physiotherapy intervention. METHODOLOGY: Study design: Single group repeated measure study. Sampling method: Simple convenience. Sample size: 40 subjects. Inclusion criteria: Patient having symptomatic mild to moderate OA knee (grade 2-3 Kellgren-Lawrence grading). Able to read \ understands English. Exclusion criteria: Severe OA knee/s (grade 4 Kellgren-Lawrence grading). Presence of cognitive, hearing or visual impairment, Undergone surgical intervention for OA knee, Intra-articular steroid in last 6 weeks, Unable to read \understand English. Methodology: After consent patient were screened for exclusion criteria. KOOS score and Lequesne’s index were explained to subjects, then self-administered. Subjects underwent physiotherapy intervention. After 21 days, all patients were called for follow up. KOOS and Lequesne’s index were re-administered. Time taken to complete each questionnaire was recorded. Normalization of score was done. Standardized response mean (SRM) used to find responsiveness of WOMAC, KOOS & Lequesne. paired t test used to find significance of time taken by patients to complete to KOOS and Lequesne. RESULT: SRM values of these outcome measures were above 0.8 indicative of high responsiveness. Comparing value of SRM, Lequesne had the highest value (SRM=2.45), Intermediate value of SRM i.e.1.84.obtained for KOOS, low value of SRM obtained for WOMAC (SRM=1.71). Time taken to complete Lequesne was significantly less compared to KOOS with value of p < 0.0001. CONCLUSION & CLINICAL SIGNIFICANCE: All three outcome measures studied were found to be highly responsive. Lequesne’s index was most responsive outcome measure with highest clinical utility in short-term follow up of mild to moderate (Grade 2-3 Kellgren-Lawrence) OA knee undergoing physiotherapy interventions. Though highly responsive, less clinical utility of WOMAC and KOOS makes them less suitable. We recommend use of Lequesne’s index for evaluation of OA knee in day to day physiotherapy practice. KEY WORD: responsiveness, clinical utility, osteoarthritis knee. E-MAIL: [email protected]



COMPARISION OF LIMB LENGTH DISCREPANCY BETWEEN

UNILATERAL AND BILATERAL T.K.R.

DR ALPA PUROHIT, DR DILIP PATEL, DR H.P.BHALODIYA AIMS-AHMEDABAD INSTITUTE OF MEDICAL

SCIENCE,LAPKAMAN,AHMEDABAD AIMS & OBJECTIVES:- To find out the difference of leg length in unilateral & bilateral TKR & find out solution of leg length discrepancy for improving patients function. PURPOSE OF THE STUDY:-To find out the difference of leg length between unilateral v/s bilateral T.K.R. METHODOLOGY:- STUDY DESIGN:- cross sectional observational study . SAMPLE POPULATION AND SAMPLE SIZE- 30 patients included according to criteria. In Group –A-15 ,unilateral Total knee replacement patients & in Group B -15 ,bilateral Total knee replacement patients were included . SAMPLING TECHNIQUE:-Convenient sampling according to selection criteria. INCLUSION CRITERIA:- Patients were operated with midline incision with primary T.K.R., Age-group 50-70yrs, Post op 3 months, Post op same exs .program in both groups, In both group pre op FFD 10-15degree & 8-10 degree varus deformity, NO any malalignment, component malposition, loosening, or patellar maltracking, No hamstring tightness, No any hip joint pathology & SI joint dysfunction. EXCLUSION CRITERIA:- Other surgical technique, Other than high flex knee joint, Other than midline incision, Post op less than 3 month, Any malalignment, component malposition, loosening, or patellar maltracking, Hamstring tightness, Any hip joint pathology & SI dysfunction OUTCOME MEASURES:- Limb length was measured by using Tape measurement method(TMM) in centimeters. DATA COLLECTION & ANALYSIS:- Data were collected from sterling hospital,ahmedabad at post 3 months of surgery . Limb length measurement was done in the supine position with pelvis squared . The lower limbs were placed parallel to the body and limb length measurement (in centimeters) done from the anterior superior iliac spine to the medial malleolus using a measuretape. The measurement was taken twice by two different observers and the mean of the two values was recorded. Outcome parameters were analysed with t-test in both group . RESULTS:- Data was analysed by using Paired t-test . The t-value for unilateral T.K.R. was 9.73 (p<0.001) highly significant and bilateral T.K.R was 3.58 (p<0.05) respectively. CONCLUSION:- In unilateral T.K.R. there is a significant difference in leg length between operated & non-operated leg & in bilateral there is no much leg length discrepancy between both operated leg. So in unilateral T.K.R. ,Limb length discrepancy is due to other leg’s arthritis condition which may cause imbalance in gait . We can give sole compensation for correcting LLD & improving gait . KEY WORDS:-limb length discrepancy, unilateral- bilateral T.K.R. E-MAIL: [email protected]



COMPARISON OF SERRATUS ANTERIOR AND TRAPEZIUS STRENGTH IN NORMAL AND IN SHOULDER IMPINGEMENT

D r . Aj i t .S .D a bh o l k ar , Dr Su j a t a Y a rd i

D e p a r tm e n t o f Ph ys io t h e r ap y, P a d . D r .D . Y. Pa t i l U n iv e r s i t y , N e r u l , Na v iM umb a i .

PURPOSE OF THE STUDY: Serratus anterior and trapezius are force couples for scapular rotation. Serratus anterior and lower trapezius are most susceptible to the effect of inhibition leading to scapular dyskinesis. Clinically objective strength assessment is seldom evaluated. Thus a paucity of research in this area stimulates us to study the strength patterns of these muscles. AIM: Comparison of Serratus anterior and trapezius strength in normal and in shoulder impingement OBJECTIVES: Assess strength of serratus anterior and trapezius in normal and in shoulder impingement. Compare strengths of serratus anterior and trapezius in normal and in shoulder impingement. Assess and compare strength ratios of trapezius in normal and in shoulder impingement. METHODOLOGY: Study design: Cross-sectional study Sample population and sample size: 30 patients of impingement shoulder Sampling: Random Inclusion criteria: Patients diagnosed with impingement syndrome, Hawkin’s Kennedy and Neer’s test positive Exclusion criteria: Rotator cuff tear, Frozen shoulder, neuro-musculoskeletal abnormality, congenital problem Outcome measure: serratus anterior and trapezius strength(upper ,middle and lower) were measured using Kendall’s and Hislop’s method. The strength was assessed using hand held push-pull dynamometer. The average of the three reading were recorded in kgs DATA COLLECTION AND ANALYSIS: The strength assessment of serratus anterior and trapezius were measured and analyzed for mean differences utilizing paired t-test. RESULTS: Significant differences were seen in strengths of serratus anterior and trapezius (p<0.001), Significant differences were noted in trapezius strength ratios(p<0.001) CONCLUSION: Serratus anterior and trapezius strength are impaired in patients with impingement CLINICAL SIGNIFICANCE: Serratus anterior and trapezius strength should routinely be assessed clinically. Emphasis for strengthening the same should be done early. KEY WORDS: Serratus anterior,trapezius, ,shoulder impingement, scapular dyskinesis EMAIL: [email protected]



EFFECT OF DEEP CERVICAL FLEXOR MUSCLE FATIGUE ON CERVICOCEPHALIC KINESTHETIC SENSIBILITY

Ravi Shankar Reddy

MCOAHS. Manipal

OBJECTIVE: The aim of the study was to determine Effect of deep cervical flexor muscle fatigue on Cervicocephalic kinesthetic sensibility METHODOLOGY: Study Design: pre test post test design. Sample population and sample size: 25 asymptomatic young adults (age range, 18–30 years) were recruited in to the study. Sampling Technique: convenience Outcome measure: Repositioning errors (Degrees) The subjects were measured for reposition errors (degrees) by the Cervicocephalic kinesthetic sensibility tests which include Head-to-Neutral Head Position (NHP) repositioning tests and Head-to-Target repositioning tests with Cervical Range of Motion (CROM) Device. The two repositioning tests were performed in the sagital, transverse, and frontal planes. The subjects were introduced to deep cervical flexor (DCF) muscle fatigue protocol and reposition errors were measured post fatigue protocol. RESULTS: The results of paired t- test for pre-post comparison of Head To Neutral Head Position and Head To Target Repositioning tests within the groups showed a significant difference in sagital plane (flexion and extension) with p ≤0.001 and no difference in frontal (side flexion-right and side flexion-left) and transverse plane (rotation-left and rotation-right) movements CONCLUSION AND CLINICAL SIGNIFICANCE: DCF muscle fatigue will alter cervical position sense in sagital plane movements. So endurance of these muscles might play vital role in maintaining cervical position sense KEY WORDS: Kinesthesia, Proprioception, Muscle fatigue, Deep cervical flexors EMAIL: [email protected]



PREVALANCE OF IMPAIRED ENDURANCE OF CORE

MUSCLES OF LOWER BACK IN PHYSIOTHERAPY STUDENTS

Ankur Parekh, Dr. Neela Soni

Govt. Physiotherapy College , Ahmedabad. PURPOSE OF THE STUDY: To estimate the prevalence of impaired endurance of core muscles of lower back. METHODOLOGY: Study Design: Cross-sectional observational study Sample Size: 200 normal healthy individuals. Sampling Technique: Random sampling technique Material Used: Pressure biofeedback machine, assessment sheet, Inclusion Criteria: Both males and females, normal healthy individuals aged 18 to 25 years. Exclusion Criteria: Spinal injury, Spinal surgery, Spinal deformity, any Neurological Condition, any Cardiopulmonary Condition. Outcome Measures: Pressure biofeedback unit. DATA COLLECTION: Subjects were randomly selected and were explained about the procedure and consent was taken before the procedure. In this procedure, endurance of the core muscles was measured by using pressure biofeedback unit. RESULTS: 70% prevalence rate of impaired core muscles endurance of lower back in physiotherapy students. CLINICAL CONCLUSION: Core muscles endurance testing & training should be emphasized in physiotherapy students to prevent musculo-skeletal dysfunction related to low back pain KEY WORDS: Core muscles, Endurance, lower back, pressure biofeedback machine E-MAIL: [email protected]



PREVALENCE OF CHRONIC NECK PAIN AND IMPAIRED ENDURANCE OF DEEP CERVICAL FLEXORS IN LONG TERM

COMPUTER USERS

Maulik Shah, Jayshree Sutaria, Yagna Shukla, Anjali bhise Government Physiotherapy College, Civil Hospital, Ahmedabad.

AIMS & OBJECTIVE: To see the prevalence of chronic neck pain and impaired endurance of deep cervical flexors in long term computer users. MATERIALS AND METHOD: A cross-sectional observational study was done on 100 computer users to obtain information from them, using computers for at least 4-5 hours per day and since last 1 year from various software companies and civil hospital, Ahmedabad. Incidence of neck pain and functional disability is observed using” COPENHAGEN NECK FUNCTIONAL DISABILITY SCALE” having practicality & reliability of 0.90 and Performance Endurance Index measured with pressure bio feed back stabilizer. SAMPLING METHOD: Random Sampling technique. INCLUSION CRITERIA: Inclusion criteria include individuals (aged between 20-50 years) using computer for at least 4-5 hours per day and since last 1 year. EXCLUSION CRITERIA: Exclusion criteria include Vertebro basilar insufficiency symptoms, any condition involving cervical spine including fracture or dislocation, recent undergone surgery or acute inflammatory problem, tumors, ankylosing spondylitis, pregnant women, person with rheumatoid arthritis. RESULTS: The study suggested that 80% individuals from the sample group have neck pain and functional disability and impaired deep cervical flexors endurance as suggested by Copenhagen neck functional disability scale, performance endurance index. Result obtained by both Copenhagen neck functional disability scale and performance endurance index show correlation that can be find out using chi-square test. CONCLUSION: Data’s collected above suggested that there is a high prevalence of neck pain and impaired deep cervical flexors in long term computer users. KEY WORDS: Chronic neck pain and impaired endurance, Copenhagen neck functional disability scale, performance endurance index, long term computer users. E-MAIL: [email protected]



MUSCULO SKELETAL DISORDERS AMONG PHYSIOTHERAPISTS.

Yagnesh Gamit, Neela Soni, Yagna Shukla, Anjali Bhise

Government Physiotherapy College, Civil Hospital, Ahmedabad

INTRODUCTION AND PURPOSE OF THE STUDY: Physiotherapists are known to be prone to work related musculoskeletal disorders(WRMDs) but its prevalence among physiotherapists in Ahmedabad has not been reported. The purpose of this study is to investigate the prevalence and work factors of WRMDs among physiotherapist of Ahmedabad. METHODOLOGY: a) Study design: cross sectional survey. b) Sample population: physiotherapist of Ahmadabad. Sample size: 200. c) Sampling technique: convenient sampling. d) Inclusion criteria: physiotherapist (both male and female) who agreed to participate in the study. e) Outcome measures: occupational health and the practice of physiotherapy questionnaire. f) Data collection & analysis: data were collected using occupational health and the practice of physiotherapy questionnaire. The data were analysed by descriptive statistics of frequency and percentages and interferential statistics of x². RESULTS: Prevalence of WRMDs among physiotherapists of Ahmedabad is 86.5% and it is significantly higher in female physiotherapist and those with lower body mass index. The Low back (65%) is the most commonly affected body part followed by the neck (31%). CONCLUSION: The study reveals that the WRMDs among physiotherapists of Ahmedabad are high. So physiotherapists should also take care of themselves by using coping strategy. KEY WORDS: Work related musculoskeletal disorders, occupational health and the practice of physiotherapy questionnaire. E-MAIL:- [email protected].



ILIOTIBIAL BAND TIGHTNESS AND PATELLO FEMORAL

PAIN SYNDROME

Paras Bhura, Jayshree Sutaria, Yagna Shukla, Anjali Bhise Govt. Physiotherapy College, Civil Hospital, Ahmedabad

AIM AND OBJECTIVES OF STUDY: To observe iliotibial band tightness in patello femoral pain syndrome. METHODOLOGY: a) Study design: observational study. b) Sample population: physiotherapy department, civil hospital, Ahmadabad. Sample size: 60 subjects (30-case group i.e. group A and 30-control group i.e. group B). c) Sampling technique: convenient random sampling. d) Inclusion criteria: Age: 20-40 year, both sexes, Patients diagnosed with patella femoral pain syndrome, Duration of pain > 3 weeks. Exclusion criteria: Patella femoral arthritis, Referred pain from hip, Patellar tendonitis, Radicular pain, Infection of knee joint, Tumour (e.g. Knee joint and femur), History of trauma and surgery (knee and hip joint), Any systemic diseases (e.g. R.A, SLE, etc.). e) Outcome measures: ober’s test f) Data collection & analysis: Patient who fulfilled the inclusion and exclusion criteria were selected and analysed for iliotibial band tightness with ober’s test by measuring hip adduction angle. Normal healthy individual (control group) subject also checked for iliotibial band tightness. RESULTS: Statistical analysis done by using chi-square test (test of goodness of fit) which shows the result is highly significance at 1%.(p<0.01) that means presence of tightness of iliotibial band in patella femoral pain syndrome is highly significant. CONCLUSION & CLINICAL SIGNIFICANCE: This study shows iliotibial band tightness is present significantly in patello femoral pain so it suggests that testing of iliotibial band tightness in assessment of patella femoral pain is an important tool. KEY WORDS: patella femoral pain syndrome, iliotibial band tightness, ober’s test. E-MAIL: - [email protected], [email protected]



CORRELATION OF CERVICAL CORE STRENGTH AND ENDURANCE WITH CERVICOCEPHALIC SENSIBILITY IN

NORMAL ADULTS

Abhilasha Gundesha, Denissia D’souza, Dr. Mrs. Vasanti Joshi Sancheti Institute College of Physiotherapy

AIM: To study the correlation of cervical core strength and endurance with cervicocephalic sensibility in normal adults. OBJECTIVES: To find out if there is a correlation between

a. Core strength and cervicocephalic sensibility b. Core endurance and cervicocephalic sensibility c. Performance index and cervicocephalic sensibility.

METHODOLOGY: a) Study design : Cross sectional study b) Sample population : 40-60 year old adults from Pune and Mumbai cities

Sample size: 50 c) Sampling Technique : convenient sampling d) Inclusion Criteria : Normal adults without any previous history of cervical

trauma or any other cervical pathology or neck pain, with full range of motion and no history of or present neck pain. Exclusion criteria: Individuals above 60 or below 40 yrs of age, subjects diagnosed with any central nervous system disorder or vestibular disorder

e) Outcome measures : Head repositioning accuracy test ; Pressure biofeedback unit

f) Data collection: 50 subjects of the age of 40-60 yrs were assessed for cervicocephalic sensibility using the head repositioning accuracy tests in all the cardinal planes. The strength and endurance were measured using the pressure biofeedback unit (Stabilizer TM ). The endurance measured was then used to measure the performance index for an objective outcome.

g) Data Analysis- done using Graphpad software with the following tests - 1) Pearson’s correlation coefficient for correlating strength and endurance

with cervicocephalic sensibility 2) Spearman’s correlation coefficient for correlating performance index with

cervicocephalic sensibility. RESULTS: There was no significant correlation between strength and endurance with the movements of 30 º and 60 º flexion/extension and left and right rotations r < 0.2 There was a significant correlation between left and right lateral flexion and the strength/endurance with r = -0.3 There was a significant correlation between the performance index and lateral flexion/rotations/60 º extension (horizontal plane) with r = -0.3 CLINICAL SIGNIFICANCE: To emphasize on kinaesthetic training in adults along with core training program. CONCLUSION: There is no significant correlation between the cervical core strength and endurance with the cervicocephalic sensibility in normal adults. KEY WORDS : cervical core strength, endurance, kinaesthetic sensibility EMAIL– [email protected]


MUSCULOSKELETAL SECTION

DIGITAL PAPERS



CONTRASBATH V/S PLANTER FASCIA MOBILISATION IN PLANTAR FASCITIS

AIM: To study the effect of different types of treatment in case of plantar fasciitis. OBJECTIVES AND PURPOSE OF STUDY: To find the effectiveness of contrast bath / Mobilisation in treatment of plantar fasciitis. METHODOLOGY: Study design: Intervention Cross section study Sample Collection Duration : October 2009 to March 2010 Place : Physiotherapy department Number of patients : Ten Based on : Selection Criteria Total 10 patients (between 30 to 50 years of age) of chronic plantar fasciitis i.e. having pain at medial side of heel since 2-3 months & hallux dorsiflexion range < 60 degrees with reduced medical longitudinal arch profile (i.e. according to windlass test) were selected. RESULTS: Here percentage reduction in pain as compared to base line is 48.57% in the experimental group 28.16% in control group So we are getting the difference of 20.41% between the two groups CONCLUSION We can conclude that PLANTAR FASCIA MOBILISATION is effective therapeutic option in the treatment of chronic plantar fascitis. SHORT COMINGS Hospital based study. Small sample size. Antininflammatory drugs & analgesic drugs may intervene the study KEY WORKS Contrastbath, Mobilisation E-MAIL: [email protected]



ASSESSMENT OF POWER GRIP IN RELATION TO DIFFERENT WRIST POSITIONS AMONG DIFFERENT AGE

GROUPS OF MEN BY AN ELECTROMYOGRAPHY

Dr Mrs Sathiyavani.D C.U.Shah Physiotherapy College, C.U.Shah Medical Campus, Surendra Nagar,

Gujarat BACKGROUND The optimal testing position for handgrip strength, which is useful functional measure of several fitness and in hand rehabilitation. Several studies have indicated that changing body position alter grip strength. Therefore, the assessment of systemic difference between different wrist positions is necessary to establish a methodology that is clinically relevant, easy to perform and reproducible. OBJECTIVE The study was to compare the grip strength measurement for four different wrist positions in various age groups by using computerized electromyography . METHODOLOGY Source Of Data: Shridevi College of Physiotherapy & Shridevi Group of Institutions, Tumkur, Karnataka. Method of data collection: Purposive sampling Study design: comparative descriptive study. Sample size: 30 normal healthy men who were divided in to two groups with 15 subjects in each group. Group -1 has age group between 20-25 years and group –II has age group between 40-45 years. Inclusion criteria: Healthy adult men, the age group between 20-25 years & 40-45 years, Right hand dominant individuals, no history of psychiatric and neurological dysfunction. Exclusion criteria: Rheumatic diseases, any previous injuries to tendons, nerves, musculoskeletal disease, soft tissue injuries in the hand and forearm, Engaged in a regular upper limb exercise program. Outcome measures: EMG interference pattern. PROCEDURE: Thirty healthy subjects were selected and divided in to two groups .the right hand of the subject was selected for test. Assessment of power grip measured using parameter of interference pattern of EMG of flexor digitorum superficialis and compared with wrist in four positions and also the influence of age on power grip. Stastical analysis: ANOVA with post-hoc test & unpaired t-test . RESULTS: in both groups(I&II),the interference pattern of flexor digitorum superficialis ranged with different limits for the four different positions but it ranges 32-46 for 30 degree extension & 0 degree radioulnar deviation which was more than the other positions. The mean interference pattern of FDS (38.33) at 30 degree extension & 0 degree radioulnar deviation position was found to be comparatively more than other positions. In advent of ANOVA was worked out , it was found to be significant (F-ratio=10.32, df=3,11,p=0.0001). CONCLUSION: the study concluded that change in wrist positions significantly alter the grip strength . the optimal wrist position for assessment of power grip that can be clinically be used wrist in 30degree extension& 0degree radioulnar deviation. KEY WORDS: power grip strength, wrist in different positions, interference pattern& computerized EMG, age group within 20-25 & 40-45 years of adult men EMAIL: [email protected]



IMMEDIATE EFFECTIVENESS OF SUBSCAPULARIS RELEASE

IN ADHESIVE CAPSULITIS: A SINGLE CASE STUDY

Patil TP, Khatri SM, Shalini Sumbh College Of Physiotherapy, Pravara Institute of Medical Sciences (PIMS), Loni

AIM: To evaluate the immediate effectiveness of subscapularis release on adhesive capsulitis. PURPOSE: Regaining adequate glenohumeral external rotation is believed to be essential for restoring the ability to reach overhead. Gain in external rotation pose major problem for therapist. Further Subscapularis release, it promotes changes in the myofascia, thus improving range of motion immediately. METHODOLOGY: Study Design: Single case study. Subjects: A 50 year male patient diagnosed as right sided adhesive capsulitis. Materials: Universal Goniometer Procedure- A 50 year male patient diagnosed as right sided adhesive capsulitis was referred to physiotherapy department with complains of pain (8.3/10 on visual analogue scale) on active shoulder and difficulty in shoulder movement mainly in active shoulder external rotation (380) since nine months. Hence, an attempt was done to find an immediate effectiveness of subscapularis release in adhesive capsulitis. Outcome measures: Intensity of pain on visual analogue scale, Range of motion. RESULTS: It was found that there was a significant improvement in active external rotation range of motion (520) and decrease in pain at shoulder (6.8/10 on visual analogue scale). CONCLUSION: Subscapularis release was found to be effective technique to improve active shoulder external rotation primarily with flexion and abduction. It was also helpful in reduction of pain in adhesive capsulitis patients. CLINICAL SIGNIFICANCE: subscapularis muscles should be considered while treating patients with adhesive capsulitis. KEY WORDS: Subscapularis muscle, active external rotation, soft tissue release technique, adhesive capsulitis. EMAIL: [email protected]



THERAPEUTIC MANAGEMENT OF THE HALLUX RIGIDUS - A SYSTEMATIC REVIEW

Anoop Aggarwal, Dr Suraj Kumar

Pandit Deen Dayal Upadhyaya Institute for the Physically Handicapped, New Delhi.

AIMS: Aim of the present review was to systematically review the literature available for therapeutic management of the hallux rigidus by identifying and evaluating the randomized controlled trials (RCTs) and non-RCTs. OBJECTIVE: Hallux rigidus is a chronic, disabling condition of foot characterized by reduced great toe extension. The manual therapy approaches are described theoretically however their practical published evidence has not been analyzed well. METHODS: Study design: - Systematic review Sample population: - The hallux rigidus patients who had received physical therapy interventions. Sampling: - The extensive database search to select the articles according to the inclusion and exclusion criteria Outcomes: - PEDRO (physical therapy evidence database) quality score of the selected studies. Method of data collection:-To view the hallux rigidus and its rehabilitation, a web based published literature search of Pubmed, Ovid Medline, Science direct, Cochrane Database, PEDro database, CINAHL was conducted for last 35 years in august 2010 using 4 specific key words “hallux rigidus, physical therapy, chiropractic, manual therapy”. Statistical analysis: the PEDro scale scores were considered. The studies having score more than or equal to the 50% of total score, were considered to be good study; while the studies having quality assessment score less than 50% of total score, was considered to be the study of inferior quality. RESULTS: The review finds that there is acute need of the quality studies and RCTs for the manual therapy, chiropractic or physiotherapeutic management of the hallux rigidus. CLINICAL SIGNIFICANCE: Review concludes that conservative programs for hallux rigidus consists of comprehensive intervention program that includes the great toe mobilization, toe flexor strengthening, sesamoid bones mobilization and long axis traction of the meta-tarso-phalangeal joint. The clinician should put an emphasis on the mobilization program with proper follow up along with comparative studies for rehabilitation of hallux rigidus. KEY WORDS: metatarsalgia, great-toe pain, traction, manual therapy. E-MAIL: [email protected]



DYNAMIC BALANCE AND MOBILITY IN MALES WITH KNEE OSTEOARTHRITIS

Dr. Dhruvkumar P. Dave

Charotar Institute of Physiotherapy, Changa, Anand, Gujarat

AIMS & OBJECTIVE: To compare the dynamic balance & mobility in knee osteoarthritis (OA) male patients and their healthy counterpart with the use of step up test and time up and go test PURPOSE OF STUDY: Knee osteoarthritis affects daily activity leads to dependency in walking, stair climbing and other lower extremity task. The purpose of this study is to assess dynamic balance and mobility as balanceis an integral component of such activity of daily living. METHODOLOGY:

a. Study Design:Cross-sectional observational study b. Sample population & sample size: 60 males in the age group of 35 – 75 years

(57.34 ± 2.15) were divided into two groups: Group A: 30 males who have bilateral osteoarthritis knee Group B: 30 healthy asymptomatic males

c. Sampling Technique: Subjects were selected by sample of convenience d. Inclusion criteria: Group A includes bilateral OA knee, knee pain >3/10 on

numerical rating scale on most of the days of previous month. Exclusion criteria: previous physiotherapy treatment, knee replacement surgery, any severe medical condition, knee injury in the past

e. Outcome measures: Time up and go test (TUG) for mobility was measured with stop watch, tape measure and arm chairwhile Step up test (SUT) for dynamic stability was measured by step with height of 15cms.

f. Data collection & Analysis: Statistical analysis was done with student’s t-test for finding the difference between age, BMI, dynamic balance (SUT scores) and mobility (TUG scores).

RESULTS: show significant difference in SUT scores 6.74 (p< 0.01) and TUG scores 5.34 (p < 0.01) between Group A& Group B. CONCLUSION: Patients with osteoarthritis knee have poorer balance and dynamic mobility which will hamper their participation in daily living activities compared to their healthy counterparts. KEYWORDS: dynamic balance, osteoarthritis, mobility. EMAIL: [email protected]



PREVALENCE OF WORK-RELATED MUSCULOSKELETAL PAIN IN PHYSIOTHERAPY STUDENTS IN AHMEDABAD

Neha Mukkamala, Dr Nehal Shah

SBB College of Physiotherapy, VS hospital, Ahmedabad, Gujarat. AIM OF THE STUDY: To see the prevalence of work-related musculoskeletal pain in physiotherapy students of Ahmedabad. PURPOSE OF THE STUDY: To find out if physiotherapy students suffer from musculoskeletal pain because of clinical work. Work-related musculoskeletal disorders (WMSDs) are injuries that result from work events. The injury rate among hospital workers has been estimated to be twice that of other service industries. Activities involving patient contact are highly correlated with occupational injuries among health-care workers. High levels of patient contact, as well as other variables in the health care environment that are thought to cause injuries, are common in the field of physiotherapy. Physical therapists are at risk for developing work-related musculoskeletal problems because they are often involved in physically demanding and intense, repetitive tasks in their practices. METHODOLOGY Study design-Observational study Sample size-220 Physiotherapy students including final year students, interns, first and second year MPT students Sampling technique-Convenience sampling Inclusion criteria-Participants involved in direct patient care for at least two hours a day with at least two years of practice in their current work settings. Exclusion criteria- First, second and third year physiotherapy students. Previous musculoskeletal injury in the last twelve months Outcome measure-Nordic Musculoskeletal Questionnaire DATA COLLECTION AND ANALYSIS-The Nordic Musculoskeletal Questionnaire was administered to final year, interns and MPT students of various Physiotherapy colleges of Ahmedabad. Informed consent was taken prior to administering the questionnaire for participation in the study. The participants were explained on how to fill up the questionnaire. Data were collated and analyzed using the statistical software SPSS, version 11.5 and percentage of students suffering from pain was calculated. RESULTS-Work-related musculoskeletal pain due to clinical work is prevalent among physiotherapy students of Ahmedabad. Low back pain was the most prevalent (66.81%), followed by upper back (39.09%), knee (36.81%), neck (32.28%), shoulder (31.81%), ankle (25.90%), wrist (21.81%), hip (15.45%), elbow (10.45%) and no musculoskeletal pain in any joint (3.63%). CONCLUSION- Work-related musculoskeletal pain is prevalent in physiotherapy students involved in clinical work. The practice of physical therapy requires performing many labor-intensive tasks like lifting, bending, twisting, reaching, performing manual therapy, and maintaining awkward positions for a prolonged period of time. Therefore, physical therapists are susceptible to musculoskeletal pain. KEY WORDS-Work-related musculoskeletal pain, Physiotherapy students, Nordic musculoskeletal questionnaire. E-MAIL: [email protected]



EFFICACY OF SCAPULAR MOVEMENT WITH MOBILIZATION IN PATIENTS WITH SHOULDER

IMPINGEMENT

D r . Aj i t .S .D a bh o l k ar , Dr Su j a t a Y a rd i

D e p a r tm e n t o f Ph ys io t h e r ap y, P a d . D r .D . Y. Pa t i l U n iv e r s i t y , N e r u l , Na v iM umb a i .

PURPOSE OF THE STUDY:Scapular kinematic alterations have been demonstrated in subjects with impingement syndrome.These scapula movement alterations are believed to decrease the subacromial space by failing to move the acromion away from the humeral head during arm elevation resulting in increased compressive loads on the tendons of rotator cuff or long head of the biceps muscle.Mulligan’s movement with mobilization(M.W.M) hypothesize that positional malalignment can be corrected with appropriate gliding.Thus this research investigates the efficacy of scapular movement with mobilization in patients with shoulder impingement. AIM: Efficacy of scapular movement with mobilization in patients with shoulder impingement OBJECTIVE: Assess immediate effect of scapular movement with mobilization in shoulder impingement METHODOLOGY: Study design: Exploratory,one group pretest and posttest study Inclusion criteria: Patients with impingement of shoulder,Hawkin’s Kennedy and Neer’s test was positive. Exclusion criteria: Rotator cuff tear,Frozen shoulder Procedure: Scapula M.W.M was given to the patient,10 repetitions thrice were repeated. Outcome measures:Visual analogue scale was used to assess pain,Range of Motion in Scaption plane was assessed by using goniometer, Supraspinatus strength assessment was assessed in scaption plane ,Shoulder pain and disability index(SPADI) was assessed DATA COLLECTION AND ANALYSIS: Baseline data recorded for the outcome measures and post intervention data was statistically analyzed for the level of significance.Paired t-test was done for the same. RESULTS: Significant differences were observed with respect to various outcome measured studied.visual analogue scale pre-post(p<0.001),Range of motion pre-post(p<0.001),Supraspinatus strength pre-post(p<0.001) and shoulder pain and disability index score(SPADI) pre –post(p<0.001) CONCLUSION: Scapular movement with mobilization proved to be effective in patients with shoulder impingement CLINICAL SIGNIFICANCE: Scapular movement with mobilization can be used in patients with impingement shoulder demonstrating abnormal behaviour. KEY WORDS: scapular alteration,movement with mobilization,impingement shoulder EMAIL:[email protected]



EFFECT OF REINFORCEMENT TECHNIQUE IN IMPROVING EXTENSOR LAG DUE TO QUADRICEPS WEAKNESS IN TOTAL

KNEE REPLACEMENT.

Dr Alpa Purohit, Dr Dilip Patel, Dr H.P.Bhalodiya

AIMS-Ahmedabad Institute of Medical Science,Lapkaman,Ahmedabad AIMS & OBJECTIVES:- To find out the effect of reinforcement technique in improving extensor lag due to quadriceps weakness in total knee replacement. PURPOSE OF THE STUDY:- To find out the effect of reinforcement technique in improving extensor lag due to quadriceps weakness in T.K.R. METHODOLOGY:- STUDY DESIGN:- Comparative Experimental study SAMPLE POPULATION AND SAMPLE SIZE-Group A-experimental group -15 operated Total knee replacement patients & Group B-control group 15 patients operated Total knee replacement (both gender)by same surgeon from sterling hospital Ahmedabad. SAMPLING TECHNIQUE:-Convenient sampling according to selection criteria. INCLUSION CRITERIA:- Extensor lag due to quadriceps weakness, Operated primary T.K.R.. with high flex joint & midline incision, Pre operative fixed flexion deformity <10°, Post op. extensor lag ≤ 10 °, Age group55-60 yrs, No hamstring tightness EXCLUSION CRITERIA:- Extensor lag due to other than quadriceps weakness, Revision T.K.R.& operated with other than high flex joint & other than midline incision, Pre operative fixed flexion deformity >10°, Post op.extensor lag > 10°, Revision T.K.R ,Infected T.K.R, Unicompartment replacement, Age more than 60yrs, Any muscle tightness around knee joint, Past history of Trauma on operated side, Pathological condition such as neoplasm, vascular problem etc., Low back pain radiating to knee joint & other neurological weakness OUTCOME MEASURES: Active Goniometry for degree of lag ,WOMAC- index were taken pre treatment and post treatment, DATA COLLECTION & ANALYSIS:- Data were collected from sterling hospital Ahmedabad .Both group received electrical stimulation and conventional exercise treatment along with that group A received special reinforcement technique(Reinforcement : means “to strengthen by fresh addition, make stronger”) for quadriceps weakness . Resist dorsiflexion to facilitate contraction of ipsilateral quadriceps . Treatment was given for 6weeks once in a day & home exercise program was continue second time. Outcome parameters were analysed pre treatment & post treatment in both groups. RESULTS:- Data analyses done by Paired t-test . There was significant improvement in WOMAC (p<0.05) and active goniometry test for extension lag t-value in group A & B are 27.07,21.34 (p<0.001) CONCLUSION:- Results shows that there is a improvement in both groups.But there is a better improvement in group A than group B .So we conclude that reinforcement technique is more effective along with conventional treatment to improving extensor lag. KEY WORDS:-Reinforcement technique ,extensor lag, total knee replacement E-MAIL: [email protected]



EVIDENCE TO SUPPORT MEDIAL PATELLAR TAPPING IN PATELLO-FEMORAL ARTHRITIS

Dr. S. Herbin Samuel , Mr. Mukesh Doshi, Dr. Loganathan,

Dr.Bhavisha, Dr. Ashok.

Jaya Rehabilitation Institute and Research Center, Shree Bidada Sarvodaya Trust,

Bidada, Mandvi, Kutch, Gujarat

AIMS AND OBJECTIVES: To study the effectiveness of medial patellar taping for relief of pain in patellofemoral arthritis. PURPOSE OF THE STUDY: Patello-femoral arthritis is a common problem causing knee pain. To combat this problem medial patellar taping is incorporated into the treatement. This study was undertaken to find out whether the biomechanical and the proprioceptive effects produced by application of tape bring relief of pain. METHODOLOGY:

1. Study design: observational study 2. Sample population and sample size: 20 patients of grade 1 and

2 osteoarthritic knee 3. Sampling technique: random sampling technique 4. Inclusion and exclusion criteria: osteoarthritic knee of grade 1

and 2 are only included, study group is of age 50 to 60 years, both male and female patients are selected.

5. Outcome measures: pain assessment in pre and post medial patellar tapping

6. Data collection and analysis: The patients pain is assessed with VAS pre and post taping, compared with paired t-test

RESULTS: Medial patellar taping provides significant relief of pain and patient preference (P<0.05). CONCLUSION: Patellar taping into a medial direction is a simple, safe and cheap way of providing pain relief in patients with osteoarthritis of the patello-femoral joint. KEY WORDS: Taping, patello-femoral arthritis, VAS. E-MAIL: [email protected]



PREVALENCE OF LOW BACK PAIN IN THE YOUNG

FEMALES WEARING HIGH HEEL

Maulik Shah, Jayshree Sutaria, Yagna Shukla, Anjali Bhise

Government Physiotherapy College, Civil Hospital, Ahmedabad. AIMS & OBJECTIVE: To see the prevalence of low back pain in the young females (13-25 years age group) wearing high heels. METHOD: A cross-sectional observational study was done on 100 young female participants aging 13-25 years to obtain information from them, wearing high heels for at least 1-2 hours per day and since 1 year regularly regarding low back pain as well as any discomfort. Incidence of low back pain was observed using MODIFIED OSWESTRY SCALE, MOHANTY’S FLAT PALPATION GRADING & surface EMG for erector spinae muscle at L1/L2 & L4/L5 level. SAMPLING METHOD: Random sampling technique. INCLUSION CRITERIA: Inclusion criteria include female participant (aged between 13-25 years) wearing high heels (6-9cm) for at least 1-2 hours per day since last 1 year regularly. EXCLUSION CRITERIA: Exclusion criteria include pregnant women, person with rheumatoid arthritis, Ankylosing spondylitis, tumors, lumbar disc pathology, recent undergone surgery or acute inflammatory problem, any condition compromising spinal canal. MATERIALS: Modified oswestry scale, standard heel of 0(low), 4.5(middle), 8(high) cm, and standard EMG machine. DATA COLLECTION: Subjects that fulfill the inclusion and exclusion criteria were screened for low back pain and explained the questionnaires and consent was taken. Subjects were asked questions as in the modified oswestry scale, surface EMG was taken for erector spinae muscle, and MOHANTY’S FLAT PALPATION GRADING was done. RESULTS: The study suggest that 75 individuals from the sample group of 100 have low back pain and discomfort as suggested by modified oswestry scale, MOHANTY’S FLAT PALPATION GRADING & surface EMG for erector spinae muscle. Correlation can be established between results obtained by modified oswestry scale and EMG for erector spinae muscle using chi-square test. CONCLUSION: Data collected above suggest that there is a high prevalence of low back pain in the female wearing high heels. KEY WORDS: Modified oswestry scale, MOHANTY’S FLAT PALPATION GRADING, surface EMG, high heels, low back pain. E-MAIL: [email protected]



PREVALANCE OF BACKPAIN AMONG DENTISTS

Trusha Shah, Dr.Yagna Shukla Govt. Spine Institute

AIMS AND OBJECTIVE: 1) To study prevalence of back pain among Dentists 2) To study prevalence of Upper / Lower Back pain Study Design : Cross sectional study Sample size : 200 Sampling technique : Purposive sampling Inclusion Criteria : 1) Dentists between age of 20 to 40 yrs 2) Dentists with duration of practice more than 1 year Exclusion Criteria : 1) Dentists having traumatic back pain 2) Dentists having any degenerative changes in spine Outcome Measures : Well constructed questionnaires Data collection & Analysis : Data is collected from Interns, PGs, tutors and Professors of Govt. Dental College of CIVIL Hospital by interviewing individual Dentists. RESULTS : 1) Prevalence of Back pain among Dentists is 56% 2) Prevalence of Upper Back pain is 16% 3) Prevalence of Lower Back pain is 36% 4) Prevalence of both Upper/lower Back pain is 4% CONCLUSION : Dentists are more prone to Back pain because of their

profession KEY WORDS : Back pain, Dentists, Well constructed questionnaires EMAIL : [email protected]



MUSCULOSKELETAL PROBLEMS IN NURSES

Patel Namrata N1, Mrs.Yagna Shukla2, Mrs.Anjali Bhise 3 Guide Govt. Physiotherapy college, A‘bad.

AIM AND OBJECTIVE: To know prevalence of musculoskeletal problems in nurses of Civil Hospital, Ahmedabad. METHODOLOGY: Study Design: cross sectional prevalence study. Sample size: 100 Sampling Technique: Convenience Sampling Inclusion Criteria: nurses working in civil hospital, age 30 to 50 years. Exclusion Criteria: nurses having major medical illness, trauma. Outcome Measure: Nordic Musculoskeletal questionnaire Data collection and analysis: The method and need of the study was explained to the subjects and written informed consent was taken from each. One self- administered questionnaires was used to find out prevalence rate of musculoskeletal problems in nurses. Logical regression analysis was performed. RESULT: 92% nurses reported atleast one musculoskeletal complain. 59% shows Job, house work, hobby affection.12 months prevalence of complains of lower back is 82% followed by knee 58%,neck 34%,ankle 21%,sholder 19%. Weekly prevalence of back problem is 26%, knee 34%,ankle 20%,neck18%. Work affection is highest 26% due to back than knee 22%. CONCLUSION: Highest affected area is low back. Than knee and other joints are less affected. KEY WORDS: Nordic musculoskeletal questionnaire EMAIL ADDRESS: [email protected]



EFFECT OF PROPRIOCEPTIVE TAPING ON SHOULDER JOINT POSITION SENSE IN PATIENTS WITH PRIMARY

SHOULDER PATHOLOGY: A SINGLE BLINDED EXPERIMENTAL STUDY

Dr. Shweta S. Ratnaparkhi, Dr. Ketaki Mankikar, Dr (Mrs.) Nilima Bedekar

Sancheti Institute College of Physiotherapy, Pune

AIM: To study the effect of Proprioceptive taping on shoulder joint position sense in patients with primary shoulder pathology. OBJECTIVES: To study shoulder joint position sense pre and post proprioceptive taping in patients with primary shoulder pathology, To correlate derangement of joint position sense with a specific shoulder joint pathology. METHODOLOGY: Study design: Experimental pre-post cross sectional single blinded study. Sample Population & size: N =19 Patients with Chronic Primary Shoulder Pathology from Outpatient Physiotherapy department. Sampling technique: Convenient Inclusion Criterion: Patients willing to participate, Males and females, Chronic shoulder pathology at least = 6 weeks old, on conservative management Exclusion criterion: Surgically managed shoulder pathology, Range of abduction <90 degrees, Range of external or internal rotation <30 degrees, neural involvement. PROCEDURE: Patient seated with shoulder abducted to 90 degrees and in neutral rotation. Markers placed over the lateral aspect of olecranon process and ulnar styloid . One angle of rotation given passively with eyes open. Patient asked to reproduce same angle actively with closed eyes. Photographs taken in saggital view after both passive and active movements. 3 readings taken in a similar way. Taping done using a sports tape along the medial border of scapula along the course of rhomboid muscles upto just lateral to the spinous process without crossing the midline. Same test repeated as above. Angles and their difference measured using the MB ruler (Markus Bader software solutions). The angles and the difference were not measured for any subject till the complete data collection was done. Outcome measure: Active reproduction test for joint position sense Statistical Analysis: Paired t-test for comparing pre and post taping differences using SPSS 17 software. RESULTS: p=0.890 with mean SD=6.41 with pre taping mean= 5.7664 and post =3.83386. CONCLUSION: Results show that taping is not statistically significant (p= 0.8) however clinically the patients perspective suggests that it may be helpful in improving proprioceptive feedback especially in cases of scapular dyskinesia. The study also shows that there is a better response to taping in patients having rotator cuff pathology. KEY WORDS: Shoulder joint position sense, proprioceptive taping, primary shoulder pathology E MAIL: [email protected]



PREVALENCE OF NECK PAIN IN PHONE USERS

Dhara P. Chavda, Mrs. Nila Soni

Govt. Physiotherapy College, Ahmedabad. AIM AND OBJECTIVE: To know prevalence of neck pain in phone users. PURPOSE OF STUDY: To know the no. people from the sample taken, suffering from neck pain due to long talks on phone because of faulty neck position and percentage of neck disability in them. METHODOLOGY: Study Design: cross sectional study. Sample size: 200 Sampling Technique: Convenience Sampling Inclusion Criteria: Person using phone for 2 or more hours per day between the age 20 to 40 years. Exclusion Criteria: Patient with traumatic neck injury or vertibrobesilar insufficiency, degenerative diseases or on analgesics therapy. Outcome Measure: Neck disability Index. Data Collection: Data was collected from various corporate sectors dealing with customers on phone. RESULT: analysis showed 57% prevalence of neck pain. Its prevalence, in pain intensity 47%, personal care is 12.11%, lifting is 17.07%, reading is 23.89%, headaches is 35.57%, concentration is 51.31%, work is 77.01%, driving is 41.67%, sleeping is 10.77%, recreation is 54.32%. CONCLUSION: There is significant prevalence of neck pain in phone users. Peoples should be provided with proper ergonomic advice to avoid long term harms. There should be organize awareness camp for preventive measures for such disadvantage of phones. KEY WORDS: Neck Pain, NDI-Neck Disability Index, Phones. EMAIL: [email protected]



EFFECT OF COUPLING RHYTHMIC STABILIZATION WITH MOBILIZATION IN FROZEN SHOULDER

Dr. Seema Saini 1, Dr. T. R. Nandakumar 2, Dr Deepti Wardhan 3

1: Padmashree Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune

2, 3: Dolphin (PG) Institute of Bio – medical & Natural Sciences AIM: To find out the combined effect of Rhythmic Stabilization with Mobilization in Frozen Shoulder. OBJECTIVES:

1. To find the combined effect of Rhythmic stabilization and Mobilization on perceived shoulder joint pain, stiffness and ROM.

2. To compare the combined effect of Rhythmic stabilization plus Mobilization and mobilization alone on perceived shoulder joint pain, stiffness and ROM. PURPOSE OF THE STUDY: There was lack of evidence suggesting that Rhythmic Stabilization can be used as one of the treatment option for the Frozen Shoulder. METHODOLOGY:

1. Study design: experimental study 2. Sample population: Subjects with frozen shoulder 3. Sample size: 30 4. Sampling technique: Random sampling 5. Inclusion Criteria- Age between 40 and 60 years, Painful and restricted shoulder

movements, Stiffness in the shoulder, Pain in the shoulder for atleast 3 months 6. Exclusion Criteria- Any fracture around shoulder, Dislocation of shoulder, Previous

surgery of shoulder, Underlying articular or soft tissue pathology 7. Outcome Measure: Visual Analogue Scale & Neck Disability Index 8. Data collection: Baseline data was collected by measuring pain on Visual Analogue Scale

& Range of motion by Half Circle Standard Goniometer. Subjects were treated for 3 times per week for 4 weeks.

9. Data analysis: Data analysis was performed using SPSS 11.5 software.Independent t-test was used to calculate difference between VAS and ROM readings at 0, 2nd and 4th week. p value of 0.05 was used as level of significance. One way ANOVA was used to compare VAS and ROM within both the groups at 0,2nd and 4th week.Post hoc analysis of VAS and ROM was done using LSD at 0, 2nd and 4th week RESULTS: There is a significant difference in Abduction and Flexion range at 2nd and 4th week. There is a significant difference in flexion, extension, abduction, external rotation and internal rotation in group A but no significant difference in above ranges found in group B. In group A and B, Pain shows significant difference between 0 & 2nd week and 2nd and 4th week. CONCLUSION: Rhythmic stabilization when coupled with mobilization proved to be effective in increasing ROM and decreasing pain. CLINICAL SIGNIFICANCE: This study provides evidence for effectiveness of Rhythmic Stabilization and this will give us another technique to deal with Frozen Shoulder. KEY WORDS: Rhythmic stabilization, mobilization, frozen shoulder E- MAIL: [email protected]


NEUROSCIENCES SECTION

PLATFORM PAPERS


ABSTRACT NO 1 (NEURO 1)

EFFICACY OF A NEWER MODIFIED CIMT PROTOCOL AS A SUPERVISED HOME BASED THERAPY IN IMPROVING UPPER EXTREMITY FUNCTION FOLLOWING STROKE.

Harpreet Singh Sachdev 1, Mona Maurya 1, Anjali Syal 2, Sonia Kaundal 1

1: Neurosciences centre, AIIMS, New Delhi

2: Icon Institute of Physiotherapy, Noida AIMS: The aim of this study was to demonstrate the efficacy of a “newer” m-CIMT, based on the principles of mass practice, using client valued activities for task oriented practice in home for improving upper extremity function; to show that the outcome for the supervised home based group would be no worse than for hospital based group. OBJECTIVE: To assess the efficacy of supervised home based modified CIMT in improving upper extremity function following stroke. METHODS: An experimental pilot study with pre post design, with seven hemiparetic subjects after a single onset of stroke was done to explore the effectiveness of this newer modified CIMT model on upper extremity function. The mCIMT protocol was given 6 days a week for 90 minutes per session on consecutive days for a period of 3 weeks, and using constraint for 5 hours /day. Patients were selected after 3 months of stroke having a minimum ability as per criteria by Taub et.al. Assessment the effect of specific training on the recovery following intervention was noted for a period of six months. A total of 30 subjects with hemiparesis were selected using convenience sampling. Subjects were randomly assigned to either a group that received supervised home based m- CIMT or a group that received hospital based m-CIMT. Subjects were evaluated at baseline and at the end of the treatment (3 weeks). DATA ANALYSIS: Wilcoxin (2-tailed) test, using SPSS 11.0 software was used in the study. RESULTS: Pilot study revealed a stable pretreatment measure suggesting static impairment before intervention in all subjects (p<0.00). After intervention period subjects showed a considerable increase in the use of their arm on Wolf Motor Function Test & Motor Activity Log scales. At the end of the treatment there was improvement in GWMFT and MAL-14 in both the groups compared with the baseline (p<0.05). There was no significant difference in the magnitude of measures between the groups at the end of the treatment (p>0.05). CONCLUSION: This newer modified CIMT protocol was found to be an effective management strategy for the rehabilitation of upper extremity in stroke subjects. The effects lasted even after the period of intervention and were carried over to the home environment. Supervised home based m-CIMT was found to be as effective as hospital-based m-CIMT. KEYWORDS: stroke, modified CIMT, supervised home based, hospital based. EMAIL: [email protected]; [email protected]



EARLY SCREENING OF PERIPHERAL NEUROPATHY WITH NERVE CONDUCTION STUDIES IN PATIENTS WITH TYPE-II

DIABETES MELLITUS.

Dr Chitra Mridha 1, Dr Maneesha Despande 2 1: Dr. Ulhas Patil College of Physiotherapy, Jalgaon

2: VSPM College of Physiotherapy, Nagpur AIM & OBJECTIVE: To screen for peripheral neuropathy with Nerve Conduction Velocity in patients with Type-II diabetes mellitus. To study the motor and sensory nerve conduction in type –II diabetic asymptomatic patients by noting their latencies amplitude and Nerve Conduction Velocity and to detect possible sub-clinical abnormalities. METHODOLOGY: SOURCE OF DATA: The study has been conducted at VSPM’S COLLEGE of physiotherapy, Digdoh hills Nagpur under the guidance of Dr. Maneesha Despande. Professor, department of physiotherapy. The subjects were collected from the medicine department of VSPM’S COLLEGE. INSTRUMENTS USED: EMG-NCV SOFTWARE (RMS-EMG Mark II), Measuring tape, Weighing machine, Stature meter INCLUSION CRITERIA: Asymptomatic subjects with type II diabetes mellitus. EXCLUSION CRITERIA: Established cases of neuropathy, Juvenile diabetes, Other cases of neuropathy DATA COLLECTION AND ANALYSIS The recently diagnosed type II diabetes mellitus was taken. Nerve conduction velocity, motor nerve conduction velocity [MNCV] & sensory nerve conduction velocity [SNCV] was done. Their latencies amplitude and nerve conduction velocity was noted. The nerves taken into consideration are -----ULNAR NERVE, MEDIAN NERVE, of upper limb. TIBIAL, MEDIAL PLANTER PERONEAL NERVE of lower limb. Recording was done over the belly of the muscle using a surface electrode. The active electrode is placed over the end plate zone of the muscle. Reference electrode is placed 3cm on the tendon of the muscle. Stimulation has been performed along two sites on the nerve the distal and proximal. Distance has been measured between both sites of stimulation and to the point of recording. The conduction velocity has been calculated by:

Sensory nerve conduction was done by ring electrodes and similarly calculated. SAMPLE SIZE: 60 subject RESULT • The result shows increase percentage in latencies in most of the nerves.

• There is a slowing of nerve conduction velocities in most of the peripheral nerves.

• The sural nerve is found to be affected the most in the lower limb [53.3%].

• The sensory nerve conduction velocity is affected more than nerve conduction. CONCLUSION

By this study we conclude that early screening of diabetic peripheral neuropathy is possible with NCV. It is seen that there is electrophysiological changes evident in asymptomatic typeII diabetic patients. CLINICAL SIGNIFICANCE By early screening patients can be early put to rehabilitative exercises to prevent further complications peripheral neuropathy contributes greatly to foot ulcers. Hence early screening will help to prevent it. KEY WORDS

Diabetes mellitus, Motor nerve conduction study, Sensory nerve conduction studies, Peripheral neuropathy. E MAIL: [email protected], [email protected]



RELATIONSHIP BETWEEN BALANCE AND ANKLE RANGE OF MOTION IN ADULTS AGED 60 YEARS AND OLDER

Dr. Deepika Metange1 Dr. Vivek Kulkarni2

1: Terna Physiotherapy College

2: Sancheti Institute of Physiotherapy AIM: Relationship between balance and ankle range of motion in adults aged 60 years and older. OBJECTIVES: To determine if 1) correlation exists between age and ankle range. 2) activity levels interact with ankle range. 3) correlation exists between balance scores and ankle range. METHODOLOGY: Study Design: Correlation study Sample Population: The sample consisted of 34 subjects between the ages of 60 and 86 years (Mean = 71.9 yrs ± 6.3) with 14 males and 20 females. Sampling Method: Subjects were randomly recruited from the community and old age homes in Pune who fulfilled the following inclusion criteria. (1) Elders with the age 60 years and above,(2) who were ambulatory with or without assisted device,(3) grade of 4 or more on manual muscle testing of ankle,(4) nearly full ROM at hip and knee joints. Patients with history of neurological problems, uncorrected visual problems, foot abnormalities, or limb length discrepancies were excluded from the study. Goniometry was used for ankle active range with knees flexed at 90º and extended. Balance capabilities were measured with Multidirectional Reach Test (MDRT), Dynamic Gait Index (DGI), Tinetti Performance Oriented Mobility Assessment (POMA). Ankle ROM (individual and planer, i.e. in sagittal, frontal and total ROM) values were correlated with age, activity levels(Life Space Assessment) & Balance data for MDRT, DGI, POMA balance and gait subtest and total score using Pearsons product moment correlation coefficient ‘r’. Subjects were offered individualized feedback and simple ankle stretches and balance exercises were demonstrated. RESULTS: There was a significant relationship between ankle range, age, balance measures and activity levels. There was a strong negative correlation between age and ankle ROM (r = -0.73). Correlation values for balance measures and activity levels were higher for planer and total ROM (r =0.73) than for individual ankle ROM. Correlation values were higher for sagittal plane than for frontal plane for MDRT, but for DGI, POMA, the correlation values were higher for frontal plane. Total ROM resulted in stronger correlation with DGI, POMA total score and FR(MDRT). CONCLUSION: Correlations exist between ankle ROM and balance, age and activity levels. We can conclude that frontal plane ROM is considerably important in balance during dynamic activities as compared to sagittal plane ROM which may be more important for balance with voluntary control in AP direction. The results suggest that age related decline in ankle ROM may result in decline in function and balance control. This is an important finding as therapy directed at improving ankle ROM along with training balance strategies may help reduce the risk of falls in elderly. E-MAIL: [email protected]



TITLE: DEVELOPMENT AND GENDER DIFFERENCES OF STATIC POSTURAL CONTROL IN CHILDREN BETWEEN 3 TO 15 YEARS

USING THE mCTSIB.

Dr. Priya Satpute-Chitre, Dr. Hutoxi Writer Sancheti Institute College of Physiotherapy

AIM: To study age-wise development and gender differences of static postural control in children between 3-15 years using mCTSIB. OBJECTIVE: To determine age at which postural sway reaches adult values under different sensory conditions and if gender differences exist in the same. METHODOLOGY Study design: Normative. Sample size and population: 260 normal children aged 3-15 years. 20 adults aged 20-35 years. Sampling technique: Purposive sampling. Inclusion criteria: Normal healthy children. Normal healthy adults. Exclusion criteria: Premature birth, delayed milestones, cerebral palsy, learning disability, illness in past 3 months, obesity, malnourishment, visual deficits, gymnastics. Outcome measure: Postural sway velocity with mCTSIB using Neurocom Balance Master. Data Collection and Analysis: 260 children were divided into 13 groups between ages of 3-15 years, each group having 10 boys and 10 girls. Parents and teachers had to sign consent form and student information sheet respectively. Materials used were height chart, measuring tape and Balance Master. Subject’s height and birth date were fed. 3 trials of 4 different conditions were performed for 10 seconds each.viz.

1: Eyes open, Force plate 2: Eyes closed, Force plate 3: Eyes open, Foam 4: Eyes closed, Foam

The computer obtains sway velocity and average for 3 trials in every condition. Mean sway velocity of children was compared to adult values for age-wise and gender-wise differences. Unpaired t-test was used to find if statistical significance in sway velocities existed between children at each age and adults and also between boys and girls in the 4 conditions. RESULTS: There was no statistically significant difference (p>0.05) between sway velocity in children and adults at following ages.

1: 13 years and beyond 2: 10 years/ beyond 3: 15 years/ beyond 4: 8 years/ beyond There was statistically significant difference (p<0.05) between boys and girls at ages 5 and 9 in condition 3 and 4 of mCTSIB, girls being better than boys. CONCLUSION: 1- Adult levels of postural control are reached at age 13 years when all 3 sensory systems, visual, vestibular, somatosensory provide information. 2- Adults levels reached at 10 years when Vestibular and somatosensory system act. 3- 15 years when visual and vestibular systems provide more information. 4- 8 years when only vestibular system acts. At ages 5 and 9, girls are significantly better than boys under challenging sensory conditions. CLINICAL SIGNIFICANCE: Basis for Age-appropriate balance testing and exercise. KEYWORDS: Postural Control, mCTSIB, sway velocity. EMAIL: [email protected]



ASSESSMENT OF KNEE JOINT PROPRIOCEPTION IN

WEIGHT BEARING AND NON WEIGHTBEARING POSITIONS IN NORMAL SUBJECTS

Dr Madhavi V Lokhande 1, Dr Jaimala Shetye 2

1: Seth G.S. Medical College


AIM: To assess knee joint proprioception in weight bearing (WB) and non weight bearing (NWB) position in normal subjects OBJECTIVE: 1. To assess knee joint proprioception in weight bearing and non weight bearing position in normal subjects. 2. To assess the difference in the response angles between the two test positions. METHODOLOGY: Study design: Observational Study Sample population: 40 Normal healthy subjects, between the age group of 20-25 years were selected. Subjects with recent lower limb trauma, pain and musculoskeletal deformity involving knee and ankle were excluded. Sampling method: Subjects were selected randomly who full field inclusion criteria. Method of data collection: Right knee joint proprioception at 300 knee flexion was measured using WB and NWB methods by active test with epsilateral active limb matching response. Average of 3 response angles was taken as a final reading. Outcome measures and statistical tests: A measure of variability of individual observation was calculated by SD and coefficient of variation. Measures of variability of samples of WB and NWB methods was calculated by SE of diff. between 2means. Position sense accuracy was measured as relative error. Relative error was calculated as the arithmetic difference between test and response position. RESULTS: Present study shows that the mean of WB procedure31.97( 2.26) is away from the test position when compared with NWB procedure30.42(2.65) but the difference between the 2means is statistically significant as P<0.05. Average relative error of WB procedure(-1.865) is more as compared with NWB procedure (-0.263) and the WB procedure produced more negative relative errors (response was underestimated) CONCLUSION: There is statistically insignificant difference between the two assessment procedures while measuring knee joint proprioception. CLINICAL APPLICATION: The WB assessment of proprioception might have greatest relevance in the area of sports medicine where clinicians are particularly interested in their subjects proprioceptive and balance capacities under WB functional conditions. However it should not be used as substitute for NWB assessment which is likely to be more specific for the examined joint. KEY WORDS: knee joint proprioception, weight bearing assessment EMAIL: [email protected], [email protected]



EFFECT OF ELECTRICAL STIMULATION ON FACIAL GRADING SYSTEM IN SUBJECTS WITH EARLY FACIAL

PALSY

Megha Sheth, Neeta Vyas SBB College of Physiotherapy, Ahmedabad

AIM: To determine potential efficacy of applying electrical stimulation to Facial nerve trunk in early phase of Facial Palsy. PURPOSE: Most patients with facial palsy experience spontaneous recovery by 3 weeks to 3 months. Because Electrical Stimulation of paralyzed muscles is a popular intervention, the study was conducted to explore it as an option for enhancing recovery in patients with Facial Palsy. METHODOLOGY:- Study Design: Pre test post test, control V/S experimental group design Sample Population and Size: 50Males and Females aged 15-65 years of age Sampling Technique: Systematic Inclusion Criteria: Clinical diagnosis of lower motor neuron Facial Palsy of idiopathic origin with less than 15 days onset Exclusion Criteria: History of known cause of palsy like head injury, ear surgery, cerebro-vascular accidents. Outcome Measures: Facial Grading System Scores Data Collection and Analysis: Subjects diagnosed with Facial palsy, by ENT OPD of VSGeneral Hospital were included in the study. The study was explained and written informed consent was taken. Subjects were systematically (every second patient allocated to experimental or control group) allocated to either Group A or B. Group A was given heat in the form of IR for 10 minutes to the ear and face on the affected side for 1 week followed by electrical stimulation for 3 weeks. Parameters used for stimulation were 0.1 ms pulse duration, 50 Hz frequency (Surged faradic current), with intensity sufficient to produce 15 mild contractions of facial muscles, stimulated at each nerve trunk branch. Surge duration and interval were kept at 5 seconds each. Both groups were explained the condition, taught exercises and given advices about care required. Subjects in Group B were asked to follow up every week for 4 weeks. Data was analyzed using non parametric tests- Wilcoxin and Mann Whitney tests by SPSS. Level of Significance was kept at 5 %. RESULTS: For Group A and Group B difference in median values of Facial Grading System scores at end of 4 weeks was found to be statistically significant (Z=-4.861,Z=-4.016 respectively, p < 0.001). However at end of 4 weeks difference in median values between the groups was not found to be statistically significant (Z=-0.420,p=0.675). CONCLUSION: Outcome demonstrates neither benefit nor harm with Electrical Stimulation CLINICAL SIGNIFICANCE: Facial muscle exercises and counselling of the patient may be sufficient in the management of subjects with facial palsy in the early stage. KEY WORDS: facial palsy, electrical stimulation, Facial Grading System EMAIL: [email protected]



EFFECTIVENESS OF BUTLER’S NEURAL MOBILIZATION AND PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION FOR REDUCING

SENSORY DEFICIT OF UPPER LIMB IN CHRONIC STROKE

Shruti Bendale, Dr R. M. Singervelan

College of Physiotherapy, Pravara Institute of Medical Sciences, Loni

AIM: To find out effectiveness of Butler’s neural mobilizations in reducing affected upper extremity sensory deficits in chronic stroke subjects OBJECTIVE: To compare effect of Butler’s neural mobilizations combined with the proprioceptive neuromuscular facilitation (PNF) method with traditional therapy and PNF combined with traditional therapy and traditional therapy alone in reducing affected upper extremity sensory deficits in chronic stroke subjects PURPOSE OF STUDY: Although many approaches to the rehabilitation of motor functions are available, there is a significant shortage of therapeutic tools aiming to improve sensory deficits. It seems that exteroceptive disturbances exert some influence on the functional capacity of the affected upper extremity, especially the hand. Some authors have struggled with the problem of poststroke sensory deficits, but their reports provide little information on the rehabilitation regimes used. Therefore this study is carry out to find effective therapeutic regimen aiming to reduce sensory deficit. METHODOLOGY: Study design: Experimental design; Sample population: Chronic stroke patients came to physiotherapy OPD,PIMS,loni; Sample size: 21; divided into in 3 groups- Control group (traditional therapy): 7 Experimental group 1(proprioceptive neuromuscular facilitation & traditional therapy): 7 Experimental group 2(Butler’s neural mobilization & PNF method & traditional therapy): 7 Inclusion criteria: Post stroke period of at least one year duration, Having sensory deficit, Able to understand simple commands. Exclusion criteria: 1.severe contraindications for physical loading Outcome measures: Assessment of the two-point discriminatory sense (distance between the tips of the compass), stereognosia (identification up to 10 objects) and thermaesthesia (using hot and cold test tubes) Data collection and analysis: Pre and post treatment data was collected and stastically analysed RESULT: Analysis showed that the post intervention, two-point discriminatory sense experimental group 2 subjects were on average 4.17mm better than experimental group 1 subjects and 3.84mm better than control group subjects, that is Experimental group 2 is significantly better than that in the two other groups. For thermaesthesia, experimental group 2 subjects were on average -0.67 better than experimental group 1 subjects and -0.47better than control group subjects, that is Experimental group 2 is significantly better than that in the two other groups. CONCLUSION: Application of Butler’s neural mobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone. KEY WORDS: Butler’s neural mobilizations, proprioceptive neuromuscular facilitation, sensory deficits, chronic stroke EMAIL: [email protected]



COMPARATIVE STUDY OF CIMT & BRUNNSTROM TECHNIQUE IN THE TREATMENT OF UPPER EXTREMITY IN

PATIENTS WITH STROKE.

Dr. Suvarna Ganvir

PDVVPF’s College of Physiotherapy Ahmednagar AIM: To compare the effect of Constraint Induced Movement Therapy & Brunnstrom technique in the treatment of patients with stroke. PURPOSE: There are >120 published studies using either the original technique of Constraint Induced Movement Therapy or, in many cases, a variant. It is compared with various neurorehabilitation techniques to prove its efficacy. Brunnstrom is an approach which has proved its efficacy though it relies mainly on use of available motor synergy patterns. There are no studies that has compared these two techniques. Hence this study is thought of. METHODOLOGY: Study design: Randomised Controlled Trial Sample population &size: 30patients of stroke with hemiparesis with a maximum duration of 3months divided into 2 groups. The 2 groups were matched on initial motor deficit by assigning participants to each group in blocks on the basis of scores on the Wolf Motor Function Test (WMFT; see below) performance time (PT) scores. Sampling technique: purposive sampling Inclusion criteria: Patients who can understand the simple commands, with minimum 20oof extension in hand Exclusion criteria: medically unstable patients, major cognitive deficits. Outcome measures: MAL (QOMquality of movt, AAUTActual amount of Use test) Intervention: Patients were randomly divided into two groups. One group received CIMT & second group received Brunnstrom technique for a period of maximum 3 months. RESULTS: there was no significant improvement in the quality & amount of arm use in both groups. On the MAL arm use scale, CI therapy subjects reported a mean increase of 1.8 points, whereas controls reported mean increase of 1.7 (P<0.0001; f=3.0;). The patients’ reports were corroborated by those of their caregivers (P< 0.0001; f=0.8;). Furthermore, the MAL results were confirmed by the AAUT. CI therapy participants (n=15) showed an 87.5% increase on the AAUT arm use scale; controls (n=17) exhibited a 85% increase (P=0.0003; f= 0.5;). DISCUSSION: CI therapy is thought to achieve its therapeutic effect by 2 linked but independent mechanisms: overcoming learned nonuse and use-dependent neural plasticity. Whereas Brunnstrom believed on the practice of task based exercises, training of missing components of task & emphasis on cognitive guidance. CONCLUSION: from the study it is concluded that both CIMT & Brunnstron are equally effective in the treatment of patients with stroke. KEY WORDS: Stroke , hemiparesis, CIMT , Brunnstrom. EMAIL: [email protected]



CUSTOM-MADE OVER GROUND BODY WEIGHT SUPPORT SYSTEM: STANDARDIZATION AND FEASIBILITY IN PATIENTS

WITH STROKE

Manikandan. N Preethi, Sowmya, Shika, Shereen, Sowmyata

Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University

BACKGROUND: Body weight supported treadmill training is one of the task-specific treatment approach used in stoke rehabilitation. This approach has been used limitedly due to cost ineffectiveness of these instruments especially in small clinical set-ups to buy slow speed treadmills. Overground body weight support training could be the solution for this but lacks standardization for it efficient use. AIM OF THE STUDY: To standardize the use of custom-made bodyweight support system, assess feasibility and its effect on weight bearing symmetry and gait parameters of stroke patients. METHODOLOGY: Study design: Phase 1: Prospective observational and Phase II: Pre-post test design Sample: 150 normal subjects (75 males and 75 females) and six stroke patients Sampling method: Convenience sampling Outcome measures: Self reported questionnaire, weight bearing symmetry and gait parameters Data analysis: Descriptive statistics and Wilxocon signed rank test Phase 1: Standardization of custom-made overground body weight support system was done by applying the system in normal subjects of age group 25 to 60 years. Actual amount of weight supported, weight suspended, height and location of pulley, distance between weight and subjects were measured and analyzed for estimation of standard error of load. Phase 2: Body weight support system was applied to six stroke patients by suspending 30% of body weight and gait training was done for a period of two weeks to evaluate the feasibility and its effect on weight bearing symmetry and gait parameters RESULTS: Five percent standard error of load was noted in system indicating adjustment of weight required to compensate for the load. Patients used the body weight system comfortably without any undue risks and showed confidence and interest to stand or walk with the system. Significant improvements were noted in weight bearing symmetry (P= 0.003) and gait parameters following training in stroke patients. CONCLUSION: Custom-made body weight support system is a standard, feasible and effective method for training gait of stroke patients with minor adjustments to compensate for loading error. KEYWORDS: Gait training, Bodyweight support, Overground training, Stroke EMAIL: [email protected]



REHABILITATION FOLLOWING PURE SENSORY STROKE:

USE OF EVIDENCE FROM RESEARCH IN CLINICAL PRACTICE

Phansalkar Archana, Kapoor Dhara

TEAM Physiotherapy services

BACKGROUND AND PURPOSE: Sensory impairments are common after stroke, occurring in approximately 60% of stroke patients. In our clinic, a client presented with inability to use his right upper extremity due to lack of sensation post stroke. In order to provide the best possible care based on current evidence from research, we did an extensive search of database. We came across 9 studies that focused on active sensory training programs. Of these one study had used outcome measures and designed a treatment program that was practically feasible to implement. Our purpose was to assess the effectiveness of this sensory retraining program (SRP) in alleviating the deficits in everyday function in our subject with pure sensory stroke CASE DESCRIPTION: A 45 year old gentleman, a case of Left high parieto-occipital hemorrhage secondary to venous sinus thrombosis, who had difficulty in functional use of his right upper extremity due to lack of somatic sensation. INTERVENTION: SRP consisted of exercises focused on improving somatic sensation and functional use of contralesional hand. 30 treatment sessions of 60 minutes each were performed. AP was the treatment therapist. OUTCOME MEASURES: Sensory deficit was evaluated using Tactile letter recognition test, Paper manipulation test (PMT) and Motor sequencing. A functional test evaluated the impact of sensory deficit on activities of daily living (ADL). Subject’s self report of ability to perform ADL’s was also taken. Measurements were taken before, after and 6 weeks post intervention. All evaluations were done by DK. RESULTS: Subject showed improvement in performance of the PMT and on 3/9 tasks of the functional test. He reported increased use of his right hand in ADL’s. The effect of the intervention was stable over 6 weeks after it was stopped. CONCLUSION: 1) Results suggest that SRP did help to improve functional use of the affected extremity in our subject. 2) This case report also shows how evidence gathered from relevant research studies can help guide our clinical decision making and plan effective intervention programs. EMAIL: [email protected]



EFFECT OF VIRTUAL REALITY IN TRAINING UPPER LIMB CONTROL IN PATIENTS WITH CEREBELLAR STROKE

Dr. John Solomon. M1 , Dr. A Raja MS2

1- Department of Physiotherapy, MCOAHS, MU.

2- Department of Neurosurgery, KMC, MU PURPOSE: Virtual reality activities involve a lot of coordination of upperlimb. But the use of virtual reality in training upperlimb coordination in cerebellar patients has not yet studied so far. P5 glove is a real time motion tracking device which is mainly used in virtual games. The aim of the study was to analyze the effect of this low-cost virtual reality (VR) technology in training coordination in subjects with cerebellar disorders. METHODOLOGY: Study design: Randomized controlled trial Sample size: 35 participated in this study. Sampling: Purposive sampling Inclusion criteria: Subjects with focal cerebellar stroke between 35- 65 years Exclusion criteria: Muscle weakness (MMT < 3), deformities and contractures of the hand Outcome measures: The outcome measures were the kinetic component of the international cooperative ataxia rating scale (ICARS), virtual reality scores and self care components of FIM. PROCEDURE: The subjects were randomly allocated to experimental or the control groups using block randomization method. Subjects in the experimental group received coordination exercises using P5 glove in virtual reality and the control group performed the coordination exercises in the form of Frenkel’s exercises and arranging blocks. The subjects were trained for three weeks for 45 minutes per session. The outcome measures were taken at baseline, end of first week, ` of second week , end of third week and end of sixth week as follow up. Data analysis: For within group and between group comparison of the ICARS kinetic Function and FIM scores- Repeated Measures Anova. For within group and between group comparison of VR scores- Friedman’s Anova RESULTS: The ICARS kinetic scores (mean ± SD) of the control group at base line, and final follow up were 19.35±3.30 and 9.92±3.42 respectively. The ICARS kinetic scores (mean ± SD) of the experimental group at base line and final follow up were 18.51±3.72 and 10.88±5.38 respectively. There was a statistically significant difference (p = 0.001) in both the groups for the kinetic scores of ICARS during each interval. Similar improvements were found in the VR as well as FIM scores. There was no significant difference between the groups. CONCLUSIONS: Virtual reality training is effective in improving coordination in patients with cerebellar disorders. When compared, virtual reality training is only as effective as the conventional treatment. KEYWORDS: Virtual Reality, cerebellar stroke, incoordination, motor control EMAIL: [email protected]



EFFECT OF PHYSIOTHERAPY TREATMENT ALONG WITH SENSORY SPECIFIC BALANCE TRAINING ON BALANCE

IN TRAUMATIC BRAIN INJURY PATIENTS

Dr. Pritesh P. Yeole, Dr. G.Varadharajulu

Krishna Institute of Medical Sciences

AIM AND OBJECTIVE:-

• To study the effect of sensory-specific balance training on the balance in Traumatic brain injury patients.

• To study the effect of physiotherapy treatment (balance specific)Sensory specific balance training on Berg Balance Scale

PURPOSE OF THE STUDY:- To investigate effect of sensory-specific balance training on improvement of balance in traumatic brain injury patients. METHODOLOGY:- a) Study design:-experimental b) Sample population and sample size:-30 patients of traumatic brain injury

satisfying inclusion and exclusion criteria c) Sampling technique:-simple random sampling. d) Inclusion criteria:-

• Patients with mild to moderate traumatic brain injury.(based on GCS)

• Both Gender Included

• Medically stable Patients

• Patients who can follow simple commands

• Patients who are conscious and oriented

• Patients who have standing and walking balance problem. e) Exclusion criteria:-

• Patients who are non-cooperative

• Patients with higher cortical function deficit

• Medically Un- stable Patients. f) Outcome measure:-Berg Balance Scale g) Data collection:-patient who are fulfilling inclusion and exclusion criteria and willing to participate consent is taken. Patients are randomly assigned in study. Duration of data collection 2 months. h) Data analysis:-paired t test used RESULT:- Mean score Pre24.3(4.9) post43.7(6.2) Paired t =3.2,p<0.05 This gives rise that post score is increased as compared to pre score in Traumatic brain injury patients. this support alternate hypothesis. CONCLUSION:- Effect of physiotherapy treatment along with sensory specific balance training on balance in traumatic brain injury patients indicate that it is beneficial to improve balance in traumatic brain injury patients. KEY WORDS: Traumatic brain injury, Balance Training, Paired t test, Berg balance scale EMAIL: [email protected]



EFFECTIVENESS OF STRUCTURED DIABETES PROGRAMME FOR INDIVIDUALS WITH TYPE 2DIABETES MELLITUS.

Dr.Madhavi. K., Dr. Archana

College of Physiotherapy, SVIMS, Tirupathi-AP

AIM OF THE STUDY: To find out the effectiveness of structured diabetes programme in type 2 diabetes individuals OBJECTIVE: 1. To find out the effectiveness of structured diabetes programme in type 2 diabetes individuals on physical variation as revealed by body mass index(BMI). 2. To find out the effectiveness of structured diabetes programme in type 2 diabetes individuals on physiological variation measured by blood glucose ( fasting and post prandial). 3. To find out the effectiveness of structured diabetes programme in type 2 diabetes individuals on functional variation by 6 minute walk test. METHOD: Study design: Randomized controlled trial, experimental study. Sample population: sample size of 111 for both groups (study-51 and control-60 groups). Sampling method: Simple randomization. Outcome measures: BMI, glycemic control pre and post-prandial, 6 MWT. Method of data collection and statistical test used for data analysis: The study was done in territory care center SVIMS hospital Tirupati. Samples were randomly selected by lottery method. Inclusive criteria: 40-55 years old both male and female diagnosed as type 2 Diabetes. Exclusive criteria: Uncontrolled hypertension, musculoskeletal impairments, central or peripheral nervous system disorders and rheumatic disorders. Samples were randomly divided into control and experimental group. The control group is represented by 56 samples while the study group consists of 65 samples. The exercises prescribed for control group are aerobic exercises only whereas experimental group underwent structured diabetes programme for 12 weeks. The study parameters were recorded before and after the therapy. RESULTS: Each outcome is analyzed separately using the standard statistical test. The mean difference between pre and post therapy in control and experimental group were analyzed using t- test. The p values were significant at p<0.05. Mean difference of BMI was 3.3 to -1.53 (from controlled to exp group), glycemic control was (-17.7 to -39.6) + (-15.18+-19.83) distance (-6.5 to -1.8 from control to experimental group) and independent t test was done to find out the mean difference of the parameters between the groups and the p value were significant at p<0.05. CLINICAL SIGNIFICANCE: Based on the above results we can recommend that therapeutic structured diabetic program for people with type- 2 diabetes mellitus include both aerobic and eccentric resistance exercises. KEY WORDS: Structured programme, Diabetes, BMI, Glycemic control. EMAIL: [email protected]



CORRELATION BETWEEN FACIAL GRADING SYSTEM AND FACIAL DISABILITY INDEX IN PATIENTS WITH FACIAL

PALSY

Hiral Ganatra, Megha Sheth

S.B.B.College of Physiotherapy, Sheth V.S Hospital Campus, Ahmedabad, Gujarat

AIM OF THE STUDY- To find the correlation between two grading systems for facial palsy that is facial disability index and facial grading system. PURPOSE- The facial motor system is responsible for functions critical for physical, social, psychological well being, which would be affected with paralysis [1]. A reliable way of grading is needed to define the severity of facial dysfunction and disability to follow the progression of facial palsy. Two of the scales used to quantify the physical disability occurring due to facial palsy are facial grading system (FGS) and facial disability index (FDI). The facial grading system gives an idea about resting facial symmetry, voluntary facial symmetry and synkinesis as evaluated by therapist; it doesn’t give idea about social functioning and disability of patients, whereas facial disability index gives an idea about the physical and social disability of facial palsy patients as evaluated by patients. So the need to correlate FGS and FDI. METHODOLOGY STUDY DESIGN- Correlational study SAMPLE POPULATION AND SAMPLE SIZE - 20 patients of facial palsy from Physiotherapy OPD V.S. Hospital, Ahmedabad. SAMPLING TECHNIQUE- Selective Sampling INCLUSION CRITERIA- Subjects with facial palsy in the age group of 15 to 50 years due to any cause. EXCLUSION CRITERIA- Any other associated conditions like hemiplegia, other nerve palsies, and any other musculoskeletal condition DATA COLLECTION AND ANALYSIS-Persons suffering from Facial palsy, referred to physiotherapy OPD of VS hospital were evaluated and the study was explained. Written, informed consent was taken. Both facial gradings were taken. Data collected was analyzed and correlation was found between the physical functioning component of the FGS and FDI. RESULTS- There was a weak negative correlation (r = -0.44097) found between physical functioning component of FGS and FDI. Mean and standard deviation of FGS and FDI are respectively (43.875, +/-15.37712) and (18.8125, 2.81111). CONCLUSION AND CLINICAL SIGNIFICANCE –A negative correlation between FGS and FDI may be suggestive of subjective feeling of greater disability by the patients than the actual physical problem evaluated by the therapist. This suggests a greater need for counseling and improving patient’s confidence along with physical exercise. Higher mean of FGS is suggestive of the strength of the physical component of the FGS. But FGS doesn’t give the idea about the social disability of the patient which may be significant in facial palsy patients. Limitations- Small sample size KEY WORDS- Facial Palsy, Facial Grading System, Facial Disability Index E-MAIL- [email protected]



EFFECT OF BODY WEIGHT SUPPORT ON NORMAL LOCOMOTION.

Gaurav Mahabal, Savita Rairikar

Pravara College of Physiotherapy, Loni.

AIMS AND OBJECTIVE: To assess the effect of body weight support on temporal parameters of normal locomotion at 3 different unweighing levels i.e. 10%, 30% and 50% at predetermined speed. METHODOLOGY: Study Design: Cross sectional prospective experimental study. Sample population: 20 Male subjects in and around Loni. Sampling Technique: Simple random sampling. Inclusion Criteria: 20 Male subjects good in health and capable of walking on treadmill in age group 20-30 years. Exclusion Criteria: Female subjects, Any previous cardiovascular problem. e.g. - asthma, MI, Any previous neurological disorder e.g. - stroke, seizures, Any previous musculoskeletal problem e.g.- RA, lower limb fractures, Difficulty in following command, both verbal and visual. Outcome measures: following temporal parameters of gait obtained by CDG stride analyzer: Single and Double support time, Stance and Cycle time, Cadence. Data collection and Analysis: Subjects were made to walk at 3 different unweighing levels i.e. 10%, 30% and 50%. Initially subject were made to walk at fix speed for each unweighing level as follows.

• 10% - at a speed of 1.2 m/s each for 2 minutes

• 30% - at a speed of 1 m/s each for 2 minutes

• 50% - at a speed of 0.8 m/s each for 2 minutes Then after rest of half hour subject were asked to walk with previous speed at 0% of unweighing (Full weight bearing). The same order of assessment was used. Paired “t” test was used to test difference between unweighing at 10%, 30% and 50% with speed of 1.2, 1 and 0.8 m/s respectively. It was also used to test difference between full weight bearing and body weight support group. RESULT: there was significant increase in single support time, stance time, cycle time [p<0.01] while double support time decreased [p<0.01] in both the group i.e. full weight bearing and body weight support as unweighing increased from 10 to 50%. Cadence remained unaffected. [p>0.05] CONCLUSION AND CLINICAL SIGNIFICANCE: The decreased total double-limb support time and increased single-limb support time have implications for balance training, as a major problem in neurological gait is the lack of balance control. During the Body weight support trials, the subjects were forced to support their reduced body weight on a single limb for longer periods of time. This finding stresses the balance component of gait and thus can be incorporated during training. KEY WORDS: Body weight support, Stride analyser, Double support time. E-MAIL: [email protected]



TEST RE-TEST RELIABILITY OF SEATED FORWARD AND LATERAL FUNCTIONAL REACH IN TRAUMATIC

PARAPLEGICS.

Richa Gupta, Purusotham Chippala, Rama Prabhu .K.R.

Srinivas College of Physiotherapy & Research Center, Pandeshawar, Mangalore

AIMS AND OBJECTIVES: The first aim of the study is to determine test retest reliability of unsupported seated forward and lateral reach test in traumatic paraplegics. The second aim is to find the correlation between levels of injury, extent of injury and reach values. And the third aim is to find correlation between unsupported sitting balance and functional independence in traumatic paraplegics. PURPOSE: Lynch and associates 1998 developed the modified functional reach to assess sitting balance among paraplegics. However, this methodology is limited to measuring only person’s ability to reach forward. So, the purpose of our study is to determine the reliability of a seated forward & lateral reach. MATERIAL AND METHOD: Study design: Cross Sectional study. Sample population: Traumatic paraplegic patients Sample size: 34 Study setting : Indian Spinal Injuries Center, New Delhi. Sampling technique: Purposive sampling Inclusion criteria: Traumatic paraplegic patients, both males and females with age group of 18-45 yrs, who have completed at least 1 month of their initial phase of rehabilitation and those who were able to sit independently without external support and who were able to flex and abduct their shoulder to 900 at least for 30 seconds. Exclusion criteria: Patients with associated neurological impairments, active or terminal illness, associated complications interfering with sitting balance were excluded. Those patients who were on medications affecting balance were excluded too. Data collection and analysis: After obtaining the consent from the patient the level and extent of injury was determined by using ASIA scale. Functional independence was measured by using Spinal cord independence measure II (SCIM II). Patients were made to sit on the mat table which was kept same throughout the study and reach values, both forward and lateral reach were measured on two different occasions with the interval of 10 minutes. The data obtained was analyzed using SPSS 11.5. RESULTS: The analysis showed that modified functional reach (forward and lateral) exhibited high reliability (Inta-class Correlation Coefficient range 0.9915- 0.9998). High correlations were exhibited between lateral, forward reach values and ASIA score, SCIM scores respectively. CONCLUSION AND CLINICAL SIGNIFICANCE: The seated Forward and Lateral Reach test are reliable, and may serve as a useful outcome measure to assess sitting balance in traumatic paraplegics. KEYWORDS: Sitting balance, Traumatic paraplegia, Functional independence. EMAIL: [email protected].



TASK PRIORITIZATION WHILE DUAL TASKING AND THE EFFECT ON GAIT AMONG PATIENTS WITH PARKINSON'S DISEASE

Galit Yogev-Seligmann 1,2, Yael Rotem-Galili 3, Ruth Dickstein 4, Nir Giladi 1,5, Jeffrey M. Hausdorff 1,6,7

1Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

2The Dr. Miriam and Sheldon G. Adelson Graduate School of Medicine Sackler, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

3Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel

4 Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa,

Mount Carmel, Haifa, Israel 5Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

6Division on Aging, Harvard Medical School, Boston, MA 7Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University,

Tel-Aviv, Israel

AIM: To investigate the ability of patients with Parkinson's Disease (PD) to flexibly allocate attention while walking and dual tasking (DT). OBJECTIVE: DT while walking frequently occurs in many everyday situations. Alterations in the ability to walk while simultaneously DT have been related to gait impairment and cognitive function. PD negative impacts on both gait and cognitive function, however, it is unclear whether PD patients can utilize cognitive resources to flexibility allocate attention to walking (or the DT) by prioritizing one task over the other. METHOD: Study design: Cross sectional. Sample population: 20 PD patients and 20 healthy age-matched older adult controls. Sampling method: Convenience sample. Outcome measures: Gait speed, gait variability, and verbal fluency (VF) were evaluated, during usual-walking and under three DT conditions: 1) no specific instruction for prioritization 2) instruction to allocate attention to the walking pattern and 3) instruction to allocate attention to the cognitive task. The Verbal Fluency test served as the cognitive task. Repeated measures ANOVA were used to estimate the effect of DT and prioritization on gait. The Montreal Cognitive Assessment (MoCA) quantified cognitive function. RESULTS: Scores on the MoCA were similar in both groups. Subjects in both groups significantly

(p<0.001) increased their gait speed when prioritizing walking (from 0.98±0.14 m/sec to 1.02±0.13 m/sec in

the PD patients and from 1.22±0.18 m/sec to 1.26±0.19 m/sec in the healthy older adults) and maintained about the same gait speed when prioritizing the cognitive task (p>0.15), in comparison to the no instruction condition. In both groups, all DT conditions increased gait variability, while prioritization did not alter this gait feature; In the PD group gait variability markedly increased and reached a level associated with a high risk of falling. CONCLUSIONS: PD patients showed task prioritization abilities that were similar to age-matched controls, even though they generally walked more slowly and with higher gait variability. PD patients who do not have major cognitive impairment can apparently utilize their cognitive resources in the same manner as healthy older adults to allocate attention to gait or secondary task. CLINICAL SIGNIFICANCE: It might be appropriate to instruct some patients to make an effort to always prioritize gait to ensure safety and minimize fall risk. On the other hand, training mental flexibility using DT paradigms and instructions for prioritization might be useful for minimizing the negative effect of DT on gait in patients with PD. KEY WORDS: Parkinson's disease, gait, executive function, prioritization E-MAIL: [email protected]



Correlation between Impairments and Activity Limitations in people affected by Leprosy.

Rutvik Purani, Dr. Neeta Vyas, Dr. Megha Sheth

S.B.B. College of Physiotherapy, Ahmedabad, Gujarat. AIM : To assess the prevalence of impairments and activity limitations and to evaluate the correlation between them in people affected by leprosy. PURPOSE : To date there is little insight into the impact of leprosy impairments on Activities of Daily Living in subjects having Leprosy for some time. Therefore for complete rehabilitation, there is need of finding out prevalence of impairments and activity limitations and also to know the correlation between them METHODOLOGY: Study Design: Cross sectional survey Sample size and population: 30 people affected by leprosy living in the community Inclusion criteria:

• Diagnosis of leprosy according to Ridley & Jopling classification, referred from department of Dermatology, V.S. Hospital and people residing in local community ( Satya Jivan colony, Behrampura).

• Males and females greater than 18 years

• Disease since 6 months. Exclusion Criteria:

• Disease since less than 6 months and subjects not willing to participate Data collection and Analysis:

• The method and need of the study was explained to the subjects and written informed consent was taken from each.

• Two different self- administered questionnaires were used to assess impairments and activity limitations.

o EHF( Eye Hand & Foot) Score – for impairments of eye, hand and feet o SALSA(Screening of Activity Limitation and Safety Awareness) Score – for activity

limitation as perceived by the subject Statistical analysis was done from data collected using graph pad prism and associations were investigated using Pearsons’ correlation co-efficient RESULT : Pearson’s Correlation Coefficient (r) value was found to be 0.6419. Confidence interval lies between 0.3463-0.8215, p value is 0.0003, which shows significant correlation between activity limitations and impairments. CONCLUSION :

Substantial proportions of people affected by Leprosy perceive limitations in activities due to impairments. CLINICAL SIGNIFICANCE: Subjects having leprosy perceive activity limitations and hence the need to work on functional problems along with physical impairments. Limitations: Participation restriction was not evaluated which may also be affected. KEY WORDS: Leprosy, Impairments and Activity Limitations. E-MAIL: [email protected]



EVALUATION OF FUNCTIONAL STATUS, DEPRESSION AND LIFE SATISFACTION IN POST STROKE PATIENTS

Arati Patel, Dr Shraddha Diwan

SBB College of Physiotherapy, VS Hospital, Ahmedabad

OBJECTIVES OF THE STUDY: Aims of the study were to know functional status, depression and quality of life in long-term stroke survivors. PURPOSE: Stroke is the most common neurological problem in the world which causes high morbidity and mortality in many countries. It is the most common disease causing disability. There is not enough evidence documenting the Activity limitation level, satisfaction from life and depression in stroke survivors residing in the community after onset. So, purpose of present study was to evaluate the long term consequences of stroke in terms of activity limitations, depression and life satisfaction METHODOLOGY: Study design: cross-sectional, descriptive design Sample population: 27 post stroke patients Sampling method: Random sampling technique Inclusion criteria: co-operative, able to follow 3 step command, duration of onset >1year, diagnosis of stroke was confirmed by clinical and/or radiological findings. Exclusion criteria: Dependent in basic ADL before the stroke, other neuromusculoskeletal condition that interfered with function. Outcome measure: Functional Independence Measure, Geriatric depression scale, SF-36. Data collection and analysis: Stroke patients that completed an in-patient rehabilitation program, were evaluated in their homes using the outcome measures .Data were expressed as mean ± standard deviation (X− ± SD). RESULTS: For functional status mean score of FIM was 88 .50±28.50 (norm: 126), For quality of life in SF36 mean score of physical functioning was 39± 29.75(norm:84.2),role limitation due to physical health was 89.55 ±60.88( norm: 81), role limitation due to emotional problems was 15±10.99( norm: 81.3), energy/fatigue was 42.75±20.49( norm: 60.9), emotional well being was 78±50.75( norm: 74.7),social functioning was 47.5±33.55, (norm: 83.3), pain was 65.5±55.65 (norm :75.2),general health was 50.85 ± 40.88 (norm :72.2) and for depression GDS mean score was 8±2.25( norm :15). CONCLUSIONS Activity limitation, participation restriction due to physical health or emotional problems, post stroke fatigue and depression are highly prevalent in the chronic phase of stroke. Early detection and recognition of associated risk factors is important to treat and prevent these problems in a rehabilitation setting. KEY WORDS: Stroke, Functional status, Depression, Life satisfaction EMAIL: [email protected]



ASSESSMENT OF STANDING BALANCE IN OBESE INDIVIDUALS AND NORMALS OF AGE GROUP

20-30 YEARS –A PRELIMINARY STUDY.

Miss Disha Visharia, Mrs Vimal Telang AIIPMR, Haji Ali, Mumbai.

AIM AND OBJECTIVE OF THE STUDY: To evaluate the standing balance in young obese adults and to compare it with the age matched normal weighted individuals. STUDY DESIGN AND METHODOLOGY:

20 obese individuals (males=10; females=10) in the age group 20 – 30 years whose BMI was > 18.5 kg/m2, and 20 age matched normal weighted individuals (males=10; females=10) in the age group 20-30 years were selected randomly; their standing balance was assessed on Stable and Unstable surfaces. Subjects with any recent lower limb injury, Any history of neurological insult, Diabetes, Vestibular disorders, any lower limb joint instability were excluded. Standing balance on a Stable surface was assessed using clinical tests viz; Single leg stance test with eyes open and eyes closed, Multiple Directional Reach Test, Star Excursion Balance test &Tandem Walking Test. Standing balance on Unstable surface was assessed using instrument based test with Biodex Stability System for testing Dynamic Stability and Limits of Stability . The participants were classified into obese and normal weighted individuals by assessing the Body Mass Index (BMI), Skin Fold measurements, Waist Circumference, Waist Hip Ratio and Body frame size.

Balance test scores were compared between the normal weighted and obese groups as well as between males and females in both the groups using unpaired t test. Also Body mass Index, % body fat and waist hip ratio was correlated with the scores of the balance tests using Pearsons correlation coefficient. RESULTS: 1) Obese subjects revealed a statistically significant lower Balance performance than that of normal weighted individuals on both Stable and Unstable surfaces in both the males and females in the tests. 2) Co relation between Obesity parameters and balance scores revealed that BMI and % body fat had significant correlation with Single leg stance eyes closed, Stability index in bilateral and unilateral stance, overall performance in Limits of stability test . CONCLUSION: The impaired Standing Balance in the Obese individuals becomes an additional morbid factors along with the other co-morbidities of Obesity. Thus balance training should be considered to be incorporated in Obesity management program. EMAIL: [email protected]



A STUDY ON ASSESSMENT OF IMPAIRMENT OF BODY FUNCTION, ACTIVITY LIMITATION AND QUALITY OF LIFE IN

MALES WITH SPINAL CORD INJURY

Miss Seema Harnish Savla, Mrs. Vimal Telang

A.I.I.P.M.R, Haji Ali, Mumbai. AIM AND OBJECTIVE: To assess Impairments of Body function, Activity limitation and Quality of life in Males with Spinal Cord Injury. STUDY DESIGN AND METHODOLOGY: This is a cross-sectional study of assessment of 27 males with spinal cord injury of age>18 years of both traumatic and Non-traumatic cause. They were divided into two groups Group A- had completed their Medical Rehabilitation from AIIPMR(6 quadriplegics and 7 paraplegics) and group B- were undergoing their Medical rehabilitation (7 quadriplegics and 7 paraplegics). Individuals having any neurological problems other than spinal cord involvement were excluded. Following outcome measures were assessed for all the patients

1. Impairments of Body Function: Range of Motion, Muscle tone function, Voluntary movement function, Muscle power function, Respiratory muscle function, Muscle endurance function, Touch function, Temperature & vibration function, Proprioceptive function, Blood pressure, respiratory rate, pulse rate and Autonomic dysfunction. Delayed complications:viz; Number of bed sores present and past, Heterotrophic ossification with X-ray and ROM, andPain using VAS Scale were evaluated and recorded.

2. Gait function: Walking Index For Spinal Cord injury II (WISCI II). 3. Activity limitation:Spinal Cord Independence Measure III (SCIM III). 4. Quality of life: World Health Organization Quality Of Life- BREF (WHOQOL-BREF)

Questionnaire. The data was statistically analyzed. RESULTS:

1. The most common cause of spinal cord injury was traumatic of which road traffic accident was highest (37.03%).

2. The Rehabilitated quadriplegics, were at level of attendant dependent indoor ambulation, whereas the all the paraplegics individualswith ASIA score level was below L1 were outdoor ambulators.

3. None of the rehabilitated individualshad any active bedsore suggesting that they have learnt to prevent this complication.

4. Percentage of patients having Heterotropic ossification was highest in quadriplegics with longer duration of injury. 66.66% of the patients with Heterotropic ossification were having incomplete lesion and 33.33% were having complete lesion as per ASIA grades.

5. There was a significant positive correlation between SCIM III scores,WISCI IIscoresand WHOQOL BREF scores, indicating that better functional performance&better walking performance respectively was related to better Quality of life. CONCLUSION:Better functional performance&better walking performance respectively was related to Better Quality of life. KEY WORDS- Activity limitation, Participation restriction, Quality of life,Medical Rehabilitation E-MAIL - [email protected]



EFFECT OF PELVIC PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION ON GAIT OF CHRONIC STROKE PATIENTS

Swapnali Jaju, Dr.Vasanti Joshi


AIM - To study effect of Proprioceptive Neuromuscular Facilitation techniques to pelvic region on the gait of chronic stroke patients. PURPOSE - To improve lower extremity function and gait, by gaining control of pelvic motion. OBJECTIVES - To find out effect of Pelvic PNF on – 1) Step length and Stride length of paretic and nonparetic sides, 2) Speed and Cadence. METHODOLOGY - Study Design - Randomized single blinded study. Sample Population - Patients with chronic stroke patients after 3 months. Sample size - 30 Inclusion Criteria – Diagnosis of hemiplegic secondary to CVA with symptoms lasted three months or more, Ability to walk at least 15 meters without manual assistance, with or without an assistive device, Patients have intact kinesthesia. Exclusion Criteria - If any musculo-skeletal and other neurological disorder which affects gait, Any

uncontrolled health condition for which exercise is contraindicated

Techniques -

In experimental group, Pelvic PNF and conventional therapy was given, and sequence of treatment:

Conventional therapy, Pelvic PNF - Rhythmic Initiation, Slow Reversal, Agonist Reversal, Gait training.

In control group, conventional therapy were given Outcome Measure - Ten meters walk test, Footprint method, Timed Up and Go test (TUG).

RESULTS - Data Analysis- Within group analysis: paired‘t’ test, Between group analysis: unpaired‘t’ test. In the present study, results are presented in following two categories 1. Comparison within experimental group and control group - The experimental group (P<0.000) as well as the control group (P<0.000) showed statistically significant improvement after four weeks of intervention. 2. Comparison between experimental group and control group - There was highly significant difference found between groups on mobility scale:

TUG test (P<0.000) Experimental Group (mean-8.37, SD-2.63) Control Group (mean-2.1, SD-1.06) 10 m walk test- Speed (P<0.001) Experimental Group (mean-0.12, SD-0.12) Control Group (mean-0.04, SD-0.03) Cadence (P<0.001) Experimental Group (mean-8, SD-2.62) Control Group (mean-4, SD-1.48) Footprint assessment - stride length (P<0.001) paretic side, Experimental Group (mean-9.9, SD-2.45) Control Group (mean-5.9, SD-1.61), Stride length (P<0.001) nonparetic side, Experimental Group (mean-9.5, SD-2.69), Control Group

(mean-5.3, SD-1.6) CONCLUSION AND CLINICAL SIGNIFICANCE -

Addition of pelvic PNF in conventional therapy have produced significant positive outcome in terms of functional mobility than conventional therapy alone. KEY WORDS - Pelvic, PNF. E-MAIL - [email protected]



EFFECT OF DANCE THERAPY ON BALANCE AND FUNCTIONAL OUTCOME IN PARKINSON’S PATIENT: A

CASE SERIES

Avani Shah, Anupama Paranjape, Suroshree Mitra, Ishwari Upasani, Dr.Vasanti Joshi

Sancheti Institute of College of Physiotherapy.

AIMS: To observe the effects of dance therapy on balance and functional outcome on Parkinson’s patients OBJECTIVES: 1) To observe the effect of dance therapy on static and dynamic balance in Parkinson’s patients. 2) To observe the effects of dance therapy on functional outcome in Parkinson’s patients. PURPOSE OF STUDY: To see the minor changes occurring in daily living activities due to dance therapy in this special population and can it be integrated as a another mode of intervention in Parkinson’s disease? METHODOLOGY: Study design: A Case Series Sample population and size: 4 Parkinson’s patients from the community of pune Sampling technique: Convenient Inclusion criteria: Patients diagnosed as Parkinson’s disease with Grade I & II Hoen & Yarr Exclusion criteria: Patients suffering from any other orthopaedic, neurological, cardiovascular complications were excluded. Outcome measures: Bergs Balance Scale (BBS), Unified Parkinson’s Disease Rating Scale part I,II&III (UPDRS), Timed Up &Go(TUG) , Modified Fall Efficacy Scale(mFES) . DATA COLLECTION & RESULTS: Four subjects after signing informed consent were evaluated for the exclusion criteria. Then they underwent twice a week session for a contemporary dance session for 8 weeks. At the start of the session and the end of the session the outcome measures were performed and reading were noted. The mean scores with the standard deviation are as follows BBS: mean pre 50.25 post 53.25 standard deviation: pre 6.18 post 2.5, two subjects showed improvement while other two there was no change TUG: mean pre 17.25 post 15.5 standard deviation: pre 3.12 post 1.76, three subjects showed improvement in the speed while one subject required more time. UPDRS: mean pre 12.66 post 9.81 standard deviation: pre 6.5 post 9.81, all showed improvement in II part but few also showed improvement in part I & II mFES: mean pre 111.5 post 114.5 standard deviation: pre 29.49 post 24.24, all four subjects showed improvement in confidence in activities of daily living. CONCLUSION: This study shows there is improvement in the static as well as dynamic balance and also in their functional outcome. But still there is need for more exploration and RCTS to be carried out in future to prove their significance to use as an intervention. KEY WORDS: Dance therapy, Parkinson, Balance . EMAIL: [email protected], [email protected]



COMPARATIVE STUDY OF BALANCE IN DIABETIC PATIENTS AND AGE MATCHED CONTROLS: CASE CONTROL STUDY.

Sneha Vilas Mankar, Ashutosh Sonawane, Dr. Mrs. Vasanti Joshi,

Dr. Vivek Kulkarni, Dr. Gajanan Bhalerao

Sancheti Institute College of Physiotherapy AIM: To study balance in diabetic patients and to compare it with age matched controls: Case Control Study. OBJECTIVE: To study the effect on balance in patients having diabetic in community dwelling older adults and age matched controls, to compare the effect on balance in diabetic patients and age matched healthy community dwelling older adults. PURPOSE OF THE STUDY: To find out whether any significant difference in balance between diabetic patients and age matched controls of same age group. METHODOLOGY: Study Design: Case Control Study. Sample Population: Diabetic patients and age matched controls aged between 60-75 years. Sample Size: 30 diabetic patients, 30 age matched controls. Sampling Technique: Inclusion Criteria: Patients clinically diagnosed with diabetes, Non diabetic healthy controls. Exclusion criteria: Any neurological disorder affecting balance e.g., Stroke, Multiple sclerosis, any recent traumatic condition of lower limb, any severe musculoskeletal injuries, any deformity affecting gait and balance. Outcome measures: Fullerton Advance Balance Scale, Multidirectional Reach Test, Diabetic Neuropathy Examination Score. Data collection and analysis: - Written consent was taken. Purpose and general procedures of the tests have been explained to all the subjects. Subjects have undergone general neurological and diabetic neuropathy examination to screen out neuropathy patients. Subjects have undergone tests for balance i.e., Fullerton Advanced Balance Scale and Multidirectional Reach Test. Analysis: Fullerton Advance Balance Scale: Mann-Whitney U Test:- U Value = 21.00, SIG = 0.0 Multidirectional Reach Test: Forward Reach:- t = -6.816, df = 58, 30.119, SIG = 0.00 Backward Reach:- t = -8.49, df = 58, 31.687, SIG = 0.00 Right Lateral Reach:- t = -10.294. df = 58, 31.26, SIG = 0.00 Left Lateral Reach :- t = -10.029, df = 58, 30.807, SIG = 0.00 RESULT : SIG values for Fullerton Advance Balance Scale and Multidirectional Reach test are 0.00, 0.00, 0.00, 0.00, 0.00 respectively. These represents there is significant difference in balance between diabetic group and age matched controls. Whereas, balance is more affected in age matched controls so age related degenerative changes are more responsible for impaired balance. CLINICAL SIGNIFICANCE: As age related degenerative changes affects balance, they are more responsible for risk of fall than diabetic pathologic changes. KEYWORDS: Balance, Diabetic community, dwelling older adults, Fullerton Advance balance Scale, Multidirectional Reach Test. EMAIL: [email protected]



EFFECT OF BALANCE RETRAINING UNDER CONCURRENT COGNITIVE TASK ORIENTED CONDITIONS ON STATIC AND DYNAMIC POSTURAL STABILITY IN CHRONIC HEMIPLEGIC

PATIENTS – A RANDOMIZED CONTROLLED TRIAL.

Ratnadip Sarkar, Mrs. Monalisa Pattnaik Department of physiotherapy, Swami Vivekananda National Institute of

Rehabilitation Training And Research (SVNIRTAR), Cuttack – 754010 (India). BACKGROUND: Impaired postural stability is a common sequel of stroke, imposing increased burden to community reintegration in chronic ambulatory hemiplegic patients under dual task contexts. Thus, balance training that exclusively addresses the postural stability threats under dual task contexts is an emerging topic of physiotherapy research. OBJECTIVE: To evaluate an additive effect of balance retraining under concurrent cognitive task oriented conditions on improvement of static and dynamic postural stability in chronic ambulatory hemiplegic patients under dual task contexts. METHODOLOGY: (i) Study design: Pre and Post-test non- blinded randomized control design. (ii) Setting: Department Of Physiotherapy, SVNIRTAR ,Cuttack. (iii) Study sample: 30 post-CVA (>6month; <2years) ambulatory chronic hemiplegic subjects with age ranged between 35-55years.(iv) Sampling technique: convenient sampling (v) Outcome measures: (a) Static stability (postural sway) was measured by computerized force-platform unite under dual (eye closed + mental arithmetic) task. (b) Dynamic stability was measured using Timed Up and Go Test under three task conditions (Alone, Manual & Cognitive). (vi) Procedure: After being checked with inclusion criteria (having gait velocity between 0.4 m/s - 0.8m/s on 10-metre walk test & able to maintain minimum 01min of static standing with eye closed) & exclusion criteria (having Mini-Mental Score<24 ± high fall risk Score (>10) , sever visual, auditory and perceptual problems or systemic illness ), selected 30 participants were randomly assigned to either an experimental group (n=15) or a control group (n=15). Both the groups received conventional physiotherapy (40 mins a day, 5 days a week) for 6 weeks. The experimental group received additional balance training under concurrent cognitive (metal arithmetic) tasks (40 mins / session, 3 sessions/ week) for 6 weeks. (vii) Data collection & analysis: The subjects of both the groups were evaluated pre-intervention and post-intervention (after 6 weeks) period on the basis of selected outcomes. The data obtained was analysed using a mixed design 2x2 ANOVA. All post hoc analysis was done and p was set 0.05 for statistically significant. RESULT: Both the groups showed significant improvement (p<0.05) in both static and dynamic postural stability over 6 weeks of intervention. However, the experimental group showed greater improvement over and above the control group. CONCLUSION: Balance retraining under concurrent cognitive task oriented conditions has an augmented effect on improving static and dynamic postural stability in chronic ambulatory hemiplegic patients when added to conventional physiotherapy. KEY WORDS: Hemiplegia, Postural stability, Balance retraining, Concurrent cognitive task. E-MAIL: [email protected]


NEUROSCIENCES SECTION

DIGITAL PAPERS



EFFECT OF MENTAL IMAGERY ON BALANCE IN HEMIPLEGIA

Dr. Zarna Ronak Shah, Dr. Manoj Kumar,

Shri B.G.Patel College of Physiotherapy, Anand, Gujarat AIM: to find out the effect of mental imagery in improving balance in hemiplegic patients PURPOSE OF THE STUDY: To find out effect of mental imagery on balance in hemiplegia. METHODOLOGY: Study design: experimental study. Randomised controlled trial Sampling: simple random sampling Sample size: total 20 pts. 10 in each group. Inclusion criteria: Patients suffering from hemiplegia having balance problems due to hemiplegia were included Exclusion criteria:

1. Patients having perceptual problems. 2. Patients with peripheral neuropathy. 3. Patients with ataxia. 4. Patients with peripheral vascular disease. 5. Patients of acute stroke or TIA. 6. Patients whose MMSE score is < 24.

Method: Two groups were included in this study. Each group had 10 patients suffering from hemiplegia. Pts were selected with the basis of inclusion criteria. Pts were well explained about the study and were asked to sign the consent form. Group A was a control group of patients who was given conventional physiotherapy for balance for 30 mins and then relaxation for 15 mins. Whereas group B was experimental group where patients were given 30 mins of conventional physiotherapy for balance and 15 mins of mental imagery. The relaxation and mental imagery was given by a tape. All patients in each group were treated for three weeks with frequency of 5 to 6 days of physiotherapy per week. . Out come measure: pts balance was measured with berg balance scale before and after the study. RESULTS: Mean age of pt in control group:52.8. S.D :3.92 Mean age of pts in experimental group:58.2, S.D:5.24. Mean BBS score pre test for control group:39 with S.D:4.08. Mean BBS score post test for control group:40.4 with S.D:4.39 Mean BBS score pre test for experimental group:30.4 with S.D :5.31 Mean BBS score post test for experimental group: 40.2 with S.D :4.44 Between group unpaired t-test, t=4.74, p=0.0002, df=18. This shows that experimental group has more significantly improved balance than the control group. CONCLUSION: Mental imagery technique is more effective in improving balance in hemiplegic patients when added with conventional physiotherapy. KEY WORD: mental imagery, balance, hemiplegia EMAIL: [email protected]



DIURNAL VARIATION IN THE BALANCE PERFORMANCE OF PATIENTS WITH MULTIPLE SCLEROSIS.

Dr. Anagha U. Nerurkar, Dr. Vasanti Joshi


AIM: To assess the diurnal variation in the balance performance of patients with Multiple Sclerosis. OBJECTIVES:

1) To evaluate the differences & diurnal variation in balance performance between patients with Multiple Sclerosis and control subjects. 2) To determine the impact of fatigue on the balance performance of patients with Multiple Sclerosis.

METHODOLOGY: Study Design: Observational. Sample population: Ambulatory people diagnosed with multiple sclerosis.

Normal individuals - Control Subjects matched for their age, gender, height and weight. Sample Size:36

18 patients with MS were recruited from the Multiple Sclerosis Society of India, City branch . 18 control subjects matched for their age, gender, height & weight were recruited from a variety of sources of convenience. Sampling Technique: Convenient Sampling. Inclusion Criteria: Patients who were clinically diagnosed with Multiple Sclerosis, independently ambulatory with or without cane at least for 15m, Patients without any associated cognitive or behavioral dysfunction. Exclusion Criteria: Patients with disturbed balance due to reasons other than Multiple Sclerosis, Patients who are in the relapsing phase of MS. Outcome Measures:

A. Berg’s Balance Scale B. Functional Reach Test C. Timed Up and Go Test D. Modified Fatigue Impact Scale

Data Collection & Analysis:For comparison of non parametric Mann-Whitney U test & Repeated measures analysis of variance (ANOVA) was used and for parametric independent t-test was used RESULTS: The data thus obtained was statistically analyzed. There was a significant difference (p < 0.01) in the balance performance of patients with multiple sclerosis when compared to the control subjects. There was no significant change (p > 0.05) found in the balance performance of patients with multiple sclerosis from morning to afternoon to evening. Also, there was a highly significant (0.000) increase in the perception of fatigue of multiple sclerosis patients. CONCLUSION: Balance is compromised in patients with multiple sclerosis when compared to normal individuals despite their consistency of performance throughout a single day from morning to afternoon to evening on clinical tests of balance. Also, there is no impact of fatigue on the balance performance of patients with multiple sclerosis. CLINICAL SIGNIFICANCE: Strategies such as pacing techniques and environmental mastery should be worked out to reduce the fatigue experienced by multiple sclerosis patient population so that they can be encouraged to gradually increase their physical activity levels which they had limited because of perception of fatigue. KEY WORDS: Diurnal variation, Balance, Multiple Sclerosis EMAIL: [email protected]



A COMPARISON BETWEEN PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION STRETCHING AND STATIC STRETCHING ON

IMPROVING ANKLE PASSIVE RANGE OF MOTION IN STROKE PATIENTS

Priya Bharadwaj, Anjali Suresh

Garden City College of Physiotherapy, Bangalore-49

BACKGROUND AND PURPOSE: The purpose of this study is to find the difference in effects on passive range of motion of ankle by using PNF stretching verses static stretching in acute stroke cases. Spasticity puts an excessive stress on bone that produces abnormal rotation or it inhibits physiological derotation of long bones. If not relieved at early stage, bone deformities occurs causing difficulty in movement, decrease range of motion, contracture and causing deformity leading to altered gait pattern. METHODOLOGY: Research design: Experimental study Subjects: The subjects were 30 stroke patients aged between 35 to 65 years. Sampling technique: Simple random sampling Inclusion criteria: Right and Left hemiplegics, Male and Female, Post stroke duration of 3 month to 1 year, Age group between 45-65 years, Stroke due to ischemia, hemorrhage and infarct, Brunstorms recovery stage 3 - 6 Exclusion criteria: Any fixed deformity or diabetic foot, Patient with any lower limb pathology, sensory dysfunction, perceptual dysfunction, Deep vein thrombosis, Uncooperative Patients Outcome measure: Goniometer and 10m walk test METHOD: Using the Universal goniometer the passive range of motion of the ankle was recorded. Patient was then taken for 10 m walk test. They were made to walk a distance of 10 meter marked on the parallel bar, and the time taken to cover that distance was recorded. In the study the patients were be divided randomly in three equal groups of 10 each. Group A was given conventional physiotherapy for both upper and lower limb (weight bearing activities, balance training, ADL training, bed mobility training and positioning) and PNF stretching technique of Contract Relax for the ankle. Group B were given static stretching for the ankle with the same conventional physiotherapy as given to Group A patients.PNF stretching technique of Contract Relax was given to group A for 60 second hold, 4-5 repetition, 5 days in a week for eight weeks. Static stretching was given to Group B for the same duration and intensity. Assessment of the patient’s passive range of motion was be done with goniometer and the speed of walking was assessed using 10 m walk test before the treatment, after 4 weeks of treatment and at the end of 8 weeks of treatment. Analysis of data: The data collected were statistically analyzed by using Minitab Software. The pre & post range of motion analysis, between and within the groups was done by using “t” test to determine the effectiveness of PNF stretching verses static stretching. RESULT: The results obtained in this study statistically supported Null hypothesis which has been stated as “There is no significant difference among PNF stretching and static stretching in improving ankle passive range of motion”. The statistical results are significant with “P” values (P>0.01). CONCLUSION: The study shows that there is no significant difference among PNF stretching and static stretching in ankle passive range of motion. Both PNF and static stretching equally improve the passive range of motion of ankle in stroke cases. KEY WORDS: Stroke, PNF, Static stretching, Goniometer, 10M walk test EMAIL: [email protected]



COMPUTERISED DYNO-GRAPHY IN HEMIPARESIS: CASE STUDY

Satralkar AN, Khatri SM, Anap DB & Shalini Sumbh.

College of Physiotherapy, Pravara Institute of Medical Sciences, Loni-413736

AIM: The aim of this study was to assess the gait asymmetries in terms of temporal and force gait parameters using Computer Dyno-Graphy (CDG) system in a hemiparetic person. PURPOSE: Currently, there is hardly any study about quantitative gait evaluation of temporal and force gait parameters in stroke patients, using computer dynography(CDG) and hence in the present study an attempt is done to bring in a simple, fast, less expensive and objective method of measuring temporal and force gait parameters in a subject with left hemiparesis. MATERIALS & METHODS: Subjects: A single 72 year male subject with a clinical diagnosis of right sided cerebrovascular accident. Materials: Measuring tape, CDG system. Study Design: Single case study. Procedure- A 72 year male patient diagnosed as right sided cerebrovascular accident was referred to physiotherapy department with complains of weakness in left upper & lower limbs and difficulty in walking in terms of impaired foot clearance since one and half year. His computerised gait dynography was done with Computer DynoGraphy (CDG)® system (Infotronic, Netherlands, http://www.infotronic.nl). Outcome measures: frequency, symmetry ratio, single support time, double support time, and step time. RESULTS: Asymmetry was found in frequency (30/min), symmetry ratio, single support time(left-0.370s, right-0.658s), double support time, single swing, and step time(left left 1.976s, right leg 1.987s). CONCLUSION: CDG may be considered as one of the useful clinical tool for the assessment of gait asymmetries in terms of force and temporal parameters variations in hemiparetic patient so as to plan therapeutic interventions. CLINICAL SIGNIFICANCE: To take in account the specific gait parameters to rehabilitate the patients with hemiparesis. KEY WORDS: Computer Dyno-Graphy, Cyclogram, Force graphics, Hemiparesis. EMAIL: [email protected]



COMPARATIVE STUDY OF EFFICACY OF STRENGTH TRAINING FOR LOWER EXTREMITY AND TRUNK-CORE MUSCLES VERSUS TASK

SPECIFIC BALANCE RETRAINING PROGRAM ON BALANCE PERFORMANCE IN OLDER ADULTS.

Pranjali S. Khairmode, Dr.R.Lakshmiprabha

P.T School & Centre, Seth G.S.M.C (K.E.M. Hospital Mumbai) INTRODUCTION: Ageing affects all components of Postural control. Decreased ability to maintain balance is major factor of falls and dependency amongst elderly. PURPOSE OF THE STUDY: 1.To evaluate the effect of Strengthening on balance in older adults 2.To evaluate the effect of Task specific balance training on balance in older adults. 3.To compare the effect of Strengthening of Lower Extremity & Trunk-core muscles with the task specific balance training on Balance. AIM: To compare the efficacy of Strength training for lower extremity and Trunk-Core muscles versus Task Specific Balance retraining Program on Balance Performance in Older Adults. OBJECTIVE: To Compare the efficacy of Lower Extremity Strengthening with Progressive Resistive Exercises and trunk core muscle Strengthening with Efficacy of task Specific Balance retraining on Balance Measured on (BBS, TUG, FRT) in Older adults. METHODOLOGY Study Design: Prospective Comparative Study. Sample Size: 60 Normal Healthy, ‘M’, and ‘F’ of Geriatric age Group 60-75 yrs. Sampling technique : Simple random sampling Inclusion Criteria: Normal healthy elderly [males, & females] in age group of 60-75years, with ROM (at least 80% of Normal ROM) at all the joints of lower limb and spine Exclusion Criteria: Non-significant Medical illness - Uncontrolled or Controlled, Affecting balance, Uncorrected vision and hearing affection, Cognitive Dysfunction, Acute Pain, Stiffness of Joints. Outcome Measures: Berg’s Balance Score, Functional Reach Test, Timed Up and Go, Single Leg Stance

time, Time taken to Turn 3600, Time taken for Step on stool activity given in Berg Balance scale Study Procedure: 60 Normal Elderly subjects are randomly selected and assigned to the Strength Training Group [A](n=30), and Balance Training Group [B](n=30). Participants were assessed on above measures. Group A: Elderly Participants undergoing Progressive resistive Exercises (Oxford technique) for Strength training of lower limb and Trunk-core muscle strengthening, done with the help of sphygmomanometer.

Group B: The elderly participants were given training of randomly selected activities, which are included in BBS, FRT, and TUG test, with 10 repetition of each activity. Treatment was given 3 times/week, total duration of 6–weeks, for both the Groups. Weekly reassessment was done on all balance measures. Data collection and Analysis: The data was analyzed on paired t’ test for intra group comparison, for both the groups and Unpaired ‘t’ test was applied for intergroup comparision between Group A and Group B. RESULT: Statistical significant (p<0.001) improvement is observed in Group A and Group B on each week reassessment of all the outcome measures of Balance. However the improvement found in Group B at the end of 6 weeks is more than Group A and the difference is statically significant (p<0.001) CONCLUSION: Strength of lower extremity muscles and trunk–core muscles is important in maintenance of balance in older adults, perhaps task specific balance retaining is a global approach towards balance rehabilitation showing better results than only strengthening of muscles, on balance performance in older adults. CLINICAL SIGNIFICANCE: Balance improvements by both groups of subject focuses on 2 effective intervention strategies to prevent falls in geriatric rehabilitation. KEY WORDS: Geriatric, Strengthening, Balance, Task Specific Balance retraining. EMAIL: [email protected]



EFFECTIVENESS OF COMPLEX ACTIVITY TRAINING ON THE SUBJECTS WITH PARKINSON’S DISEASE

Dr Archana Dave, Dr C.Prabhu

Padmashree College of Physiotherapy, Bangalore AIM AND OBJECTIVES: The study here is intended to find whether training Parkinson’s disease subjects by giving complex activity repeatedly while walking can improve the gait parameters. NEED FOR THE STUDY: The researches have been done to show the effect of practice on performance of a skilled motor task in patients with PD, but no emphasis has been given to the methods of training to improve the difficulty a PD patients undergoes when complex task is said to be performed simultaneously while walking. METHODOLOGY: Sampling Technique : convenient sampling Sample Population : patients with Parkinson’s disease Sample size : 30 Parkinson’s disease subjects Study design : Experimental study involving pre test and post test Measure design. Inclusion criteria: Subjects as idiopathic Parkinson’s disease, able to walk for 10 min for 10 meter unassisted, Age more than 50 or between 50-70, Webster scale score i.e. between 11-20. Out of 30. Exclusion criteria: No other neurological disorder, Contractures, Musculoskeletal disability, Unstable cardiac disease patient, On major medications, Impaired vision. Measurement tools: Stride length, Speed, Cadence Data analysis: The data was analysed using the unpaired t-test to test the differences among demographic variables, Webster scale score and also to compare outcome measured between the groups. Chi-square test was used to test the gender differences between the two groups. Paired t-test to compare outcome measured within the groups. RESULTS: Group 1: Difference in the pre and post variables Stride length – Pre – 28.75±1.90, Post – 31.50±2.13, P – value – 0.001 Speed – Pre – 0.64±0.16, Post – 0.74±0.15, P-value – 0.0001 Cadence – Pre – 96.50±3.02, Post – 99.62±3.20, P-value – 0.0001 Group 2: Difference in the pre and post variables Stride length – Pre – 27.12±3.31, Post – 28.25±3.41, P – value - 0.007 Speed – Pre – 0.61±0.13, Post – 0.63±0.13, P-value – 0.0001 Cadence – Pre – 98.87±5.13, Post – 100.62±4.92, P-value – 0.002 Above results shows significant increase in the gait parameters post training where complex activity training was given. CONCLUSION: Complex activity training is expected to produce an additive effect to the conventional gait training in subjects with Parkinson’s disease. There is a significant variation with the addition of complex activity gait training in subjects with Parkinson’s disease. CLINICAL SIGNIFICANCE: Complex activity gait training can be used during the rehabilitation to train the Parkinson’s subjects to walk without the dual task interference occurring. Hence, preventing falls. KEY WORDS: Parkinson’s disease, Gait, stride length, basal ganglia. EMAIL: [email protected]



EFFICACY OF RESISTANCE TRAINING ON FATIGUE AND QUALITY OF

LIFE IN MULTIPLE SCLEROSIS PATIENTS- A SYSTEMATIC REVIEW

Hamza N Godhrawala NHS Grampian / Independent Practitioner in India - Mumbai

INTRODUCTION: Multiple Sclerosis (MS) is the most common neurological disorder affecting young adults. The hallmark of the disease is its unpredictable nature. Of the common signs and symptoms 86% report fatigue as the most disabling symptom responsible for a poor quality of life (QoL). No intervention has proven effective in modifying long term disease prognosis in MS; however exercise therapy plays an important role in the symptomatic relief. No systematic review has been undertaken to collate the existing evidence to explain the effectiveness of resistance training on fatigue and QoL. OBJECTIVES To assess the efficacy of resistance training on fatigue and QoL in MS patients. Search strategy Relevant literature was reviewed following a comprehensive search strategy of eight computerised databases (Cochrane, Pubmed, Cinahl Plus, Pre-Cinahl, Medline, PEDro, Scopus and Web of Science) for all dates till November 2008. Selection criteria Randomized and non-randomized trials addressing resistance training alone or along with other form of exercise therapy for adults with MS, primary outcomes that included fatigue and or QOL or both were eligible for inclusion. Studies were excluded if the study was not an intervention or was a case study. Data collection and analysis Methodological quality was assessed using the PEDro rating scale and a qualitative analysis of the included studies was carried out. RESULTS The literature search review yielded an initial list of 252 citations. Eight articles met the inclusion criteria for the final review involving 187 females and 83 male participants in total. The included studies were clinically and statistically heterogeneous in design. Only two studies focused on resistance training alone, all the other trials had some other component of exercise therapy along with resistance training in their interventions. All but one failed to report statistically significant improvement in levels of fatigue following resistance training. No standardised outcome measures were used across the trials. In general, resistance training interventions alone were unrewarding and the data insufficient to prove its efficacy. CONCLUSION The results of the review suggest that resistance training can be beneficial for people with MS. The absolute and relative efficacy of resistance training alone in MS is poorly documented and thus no recommendations can be made to guide prescribing. Future research in rehabilitation should include standardised, well validated MS specific measures of fatigue and QOL with a focus on improving methodological and scientific rigour of clinical trials. KEY WORDS: multiple sclerosis, fatigue, quality of life and resistance training. EMAIL: [email protected]



SUBCLINICAL PERIPHERAL NERVE INVOLVEMENT IN HUMAN IMMUNODEFICIENCY VIRUS SEROPOSITIVE AND ACQUIRED IMMUNO DEFICIENCY SYNDROME PATIENTS

– NERVE CONDUCTION VELOCITY STUDY

Kakkad Ashish1 , Anjali Bhise2, Yagna Shukla2

1: Shri K.K. Sheth Physiotherapy College, Rajkot 2: Government Physiotherapy College, Ahmedabad

AIMS & OBJECTIVES: 1. To study the nerve conduction velocity in Human Immunodeficiency Virus seropositive patients. 2. To analyze whether it is an axonal or a demyelinating neuropathy. PURPOSE OF STUDY: One of possible neurological complications with Human Immunodeficiency Virus infection is Peripheral Nervous System affection if patient presented very late. The purpose of study is to assess the effect of Human Immunodeficiency Virus on nerve conduction study even if patient has not symptoms of neuropathy. MATERIALS & METHODS: a) Study design: Cross-sectional observational study b) Sample population and size: 18 Human Immunodeficiency Virus seropositive patients (Mean age=34.3 years) as case group and 20 normal healthy individuals (Mean age=34.3 years) as control group in Civil Hospital, Ahmedabad. c) Sampling Technique: Sample of convinience d) Inclusion criteria: Human Immunodeficiency Virus seropositive person having no clinical features of neuropathy like pain, numbness, parasthesiae, focal weakness e) Exclusion criteria: Person taking alcohol, neurotoxic drugs (vincristine, isoniazide, antiretroviral therapy, antikoch’s therapy), suffering from diabetes, uremia or family history of neuropathy f) Outcome measure: Nerve conduction studies were done on left upper and lower limb in lying. The amplitude (peak to peak) and nerve conduction velocities were measured for Median nerve (both motor and sensory), Peroneal nerve, Sural nerve using instrument (RMS-EMG-EP-MK-II, Version-1.1), measuretape, thermometer, weighing-machine, height-scale, sketch-pen, spirit, electrode gel, cotton and adhesive-tape. f) Data Analysis: Statistical analysis was done with student’s t-test. RESULTS: Analysis with student’s t-test, found t-values for Median motor nerve conduction velocity, Peroneal distal amplitude, Sural distal amplitude were 2.661, 2.324, 2.565 respectively which showed significant difference at 0.05 significance level. t-values for Median motor distal amplitude, Peroneal nerve conduction velocity, Median sensory distal amplitude, Median sensory nerve conduction velocity, Sural nerve conduction nerve conduction velocity are 0.666, 0.988, 0.913, 1.402, 0.827 respectively which showed no significant difference at 5% level. CONCLUSION AND CLINICAL SIGNIFICANCE: Results show presence of demyelinating neuropathy in Median motor nerve and axonal neuropathy Peroneal and Sural nerves suggestive of presence of subclinical peripheral nerve involvement in asymptomatic HIV seropositive patients. KEY WORDS: Nerve Conduction Study, Human Immunodeficiency Virus, Neuropathy E-MAIL: [email protected]



NEURO REGENERATIVE REHABILITATION THERAPY FOR MUSCULAR DYSTROPHY PATIENTS.

Dr. Mamta Lohia, Dr. Nandini Gokulchandran ( M.D) , Dr. Guneet Chopra

(MBBS,PGDMG), Pooja Kulkarni (MSc), Dr. V C Jacob (B.Sc, DPTH), Dr. Alok Sharma (M.S, MCh)

Neurogen Brain and Spine Institute.

Suman Nagar,Sion Trombay Road, Chembur , Mumbai AIM: We present a study with an aim to evaluate the efficacy of Neuroregenerative Rehabilitation therapy (NRRT) administered to 72 patients of Muscular Dystrophy at NeuroGen Brain and Spine Institute (Mumbai). OBJECTIVE: Our purpose was to conduct basic and clinical research to constantly work on innovation and development so that the best therapeutic strategies can be evolved to combat Muscular Dystrophy. METHODOLOGY: Study Design: The population selected for the study was thoroughly evaluated by a team of physiotherapists, occupational therapists, neurologist following which areas of weakness were identified and motor points of muscles were plotted accordingly and varied from patient to patient. Then they were administered autologous bone marrow derived stem cells intrathecally and intramuscularly. Post stem cell transplantation, they underwent extensive NeuroRehabilitation. At the end of six months they were re evaluated by the same team. Sample population: 72 cases of Muscular Dystrophy. (41-DMD, 17 –LGMD, 1-FSHD, 2-BMD, 11-CMD) varying in age groups from 6-50 years. Technique used for sample collection: Stratified random sampling where in the inclusion criteria was patients who were diagnosed cases of muscular dystrophy. Outcome measures: MMT (Manual muscle testing), Other scales & objective tools on which patients were analyzed are FIM score(Functional independence measure),EMG(Electromyography), and CPK levels & MRI of the musculoskeletal system. RESULTS: We performed a paired t test to evaluate whether there is any change in muscle strength before & after therapy , at the end of 6 months . Data analysis using t test was carried out & the difference between muscle strength before & after therapy is statistically significant (level of confidence 0.05%).This shows that there is marked difference muscle strength before & after therapy due to NRRT. During the test calculated t value is 16.14. The percentage analysis of parameters used for assessment were also performed in which 42% showed improvement in lower limb strength, 28% improved in Upper limb strength, 44% improved in trunk and abdominal strength with 38 % having improvement in their gait patterns. 75% of the patients showed reduction in their CPK values and 61% showed reduced musculoskeletal tightness. In select cases, objective changes in MRI of the musculoskeletal system (showing decrease in fatty infiltration & marginal increase in muscle fibers) & EMG was observed. CLINICAL SIGNIFICANCE: Neuro-Regenerative Rehabilitation Therapy was found to be a reliable, safe and a holistic approach in treating muscular dystrophy patients. This therapy, hence appears to provide small, though, functional gains that have significant effects on quality of life of muscular dystrophy patients. KEYWORDS: Motor points, Stem cells, Rehabilitation, Quality of life. EMAIL: [email protected], [email protected]



NEED FOR THE ESTABLISHMENT OF REHABILITATION HOMES FOR NEUROLOGICALLY DISABLED INDIVIDUALS

IN INDIA

Suvarna Ganvir

PDVVPF’s College of Physiotherapy, Ahmednagar, M.S. India

PURPOSE: Recovery of patients with neurological dysfunction usually takes a very long time. It is difficult for the rural patients to find a suitable place to accommodate once they are discharged from hospital to continue rehabilitation services. This results in either financial burden on the family or discontinuation of treatment. AIM: To explore the need for establishing rehabilitation homes for the neurologically disabled individuals OBJECTIVES : to understand the various factors hindering the rehabilitation process. To understand the perception of various personnels involved in care of neurologically disabled individuals. To evaluate the need for the establishement of rehabilitation homes for facilitating the process of rehabilitation. METHODOLOGY Study design : an observational study. Sample size & population : The study comprised of three groups of participants. One being the medical personnels involved in the primary treatment of patients(20). The second group was that of the Neurophysiotherapists involved in the care of neurologically disabled individuals(15). The third group was that of the patients or care givers who are at the receiving end(56). PROCEDURE: the target population was identified. Three separate questionnaires were prepared for each group which were pilot tested & then used in this study. Analysis: the results of the study were analysed using conditional logistic regression analysis. RESULTS : 89% of the medical personnel involved in the treatment of these patients felt that it was not possible for them to keep these patients admitted in routine wards beyond a specific time period. 67% of patients who were optimistic about their recovery with physiotherapy along with other supportive therapies felt there should be some facility wherein they could stay for longer periods of time till maximum recovery could take place. From the analysis of records of physiotherapy statistics 83% of patients could have achieved maximal recovery, had they been given the opportunity to continue taking rehabilitation services, most of which were in the paediatric age group( 67%) . Out of 7 most important obstacles pointed out by patients hindering the maximum functional recovery provision of some space or place in medical terms in the form of rehabilitation homes that can be made available for these patients. CONCLUSION : From the study it is concluded that there is a strong need for establishing rehabilitation homes for neurologically disabled individuals. KEY WORDS: rehabilitation, treatment adherence, neurological disability EMAIL: [email protected]



WORLD HEALTH ORGANIZATION GUIDELINES ON THE PROVISION OF MANUAL WHEELCHAIRS AND THE ROLE OF THE

PHYSIOTHERAPIST- A DISCUSSION

G.Sudhakar

Mobility India Rehabilitation Research and Training Centre, Bangalore – 560078 INTRODUCTION: A wheelchair is one of the most commonly used assistive devices for enhancing personal mobility to excise human rights, inclusion and equal participation. About 1 % of the global population (65 Million people) needs a wheelchair (1). It is estimated that there are approximately 8 million potential wheelchair users in India (2). It is stated that not all individuals in need of a wheelchair are in possession of one (3). Most “potential wheelchair users” receive wheelchairs through charity or mass distribution camps. A study in India revealed that 60% of wheelchair users who had received donated wheelchair, have either stopped or rejected them as they found these wheelchairs are unsuitable for their needs (4). The WHO has introduced the “Guidelines on the provision of manual wheelchairs in less resourced settings”. These guidelines seek to promote personal mobility and enhance the quality of life of a wheelchair user. They assist member states in developing systems of wheelchair provision to support the implementation of conventions on the rights of people with disabilities (specifically articles 4, 20 and 26). Since most of the professionals in India are not addressing these issues, the idea is to raise awareness among the physiotherapy profession to follow the wheelchair provision with WHO guidelines METHOD: Mobility India is a non-government organization, founded in 1994. Activities carried out by Mobility India focus on an individual’s rights to health care including rehabilitation services, advocacy, health education and social inclusion. The centre is also involved in providing structured wheelchair service provision following the WHO guidelines. Physiotherapists of Mobility India play a vital role in following key areas which meets the users need. Key areas in the guidelines are design and production, service delivery, training and policy & planning. This discussion will summaries the guidelines and highlights the importance of their use in the provision of a wheelchair. RESULTS: Professional groups can play a major role in providing quality wheelchair services and in the training of personnel and wheelchair users. This therefore enhances the quality of life of the wheelchair user. There will be an increased awareness among the different stake holders including professional groups for appropriate wheelchair provision. The guidelines play a key role in the identification of the needs and integration of wheelchair services in existing healthcare or rehabilitation services. KEY WORDS: WHO guidelines, manual wheelchair, physiotherapist EMAIL: [email protected] REFERENCES: 1) http://www.who.int/disabilities/publications/technology 2) National Sample Survey Report, 2002 3) Census of India, Government of India, 2001, Office of the Registrar General, India, Delhi,

viewed 20 April 2010, http://www.censusindia.net/ 4) Mukherjee G, Samanth A. Wheelchair charity: a useless benevolence in community- based

rehabilitation. Disability and Rehabilitation, 2005, 27:591-596



TO IMPROVE BALANCE ON FUNCTIONAL REACH TEST IN PATIENTS OF BILATERAL OSTEOARTHRITIS OF KNEES WITH EXERCISES.

Dr.Vivek Patki

K.E.M. Hospital, Pune INTRODUCTION: The term osteoarthritis, degenerative joint disease, are used to define idiopathic, slowly progressive disease of synovial joints, occurring late in life, pathologically characterized bifocal degeneration of articular cartilage, sclerosis, osteophytes, etc. Patients with O.A knee presents with pain, swelling, stiffness and Feeling of instability. These individuals suffer progressive loss of function, displaying increasing dependency on walking, stair climbing and other extremity tasks. AIM: To improve balance on functional reach test in patients of bilateral osteoarthritis of knee with exercises. OBJECTIVES: To co-relate Gender and improvement of balance in bilateral O.A knees, To find out improvements in dynamic balance using FR test. MATERIALS & METHODOLOGY Materials-Yardstick of length 1.5 m, weight cuffs, foam, mattress, plinth, stationary. Study design: experimental Sample size: 30 (17 females, 13 males) Sampling technique: random Inclusion criteria: Patients with bilateral knee pain with K/H/O.O.A., Both Genders, NRS- Less than or equals to 5 out of 10, Age limit between 40-60, Well ambulating patients. Exclusion Criteria: Diabetes Mellitus, NRS more than 5 out of 10, Patients using walking aids, Cardiac disease, Unable to stand for 30 sec with eyes closed, Fractures, visual disorders, Neurological disorders. Outcome Measure: The Functional Reach Test (FR) was developed by Duncan & Co-workers to provide a quick screen of balance problems in older adults. EXERCISE PROGRAMME (4 Weeks); Strengthening Exercises: Quadriceps, hamstrings, Hip Flexors 10 Rep.Each. Achilles stretching with knee straight 3 sets X 20 sec. Short – foot concept contraction 3 times X 80 sec. High knee Walking 2 Sets X 10 Rep. Lateral Side Steps 2 Sets X 10 Rep. Walking Exercises (forward & backward) 2 Sets X 10 Rep. Lunges 2 Sets X 10 Rep Squats 2 Sets X 10 Rep. One Leg Standing (Eyes Open) 30 sec. X 10 Rep. One Leg Standing (Eyes Open) 30 sec .X 10 Rep. Standing on Foam (Eyes Open) 30 sec. Walking on Straight line. Followed by Achilles Stretching. After these exercises, post Exercise F.R.Value was taken & difference in between Post & pre was taken for analysis. Data Collection: Out of 30 people, 19 showed no change while only 11 people (including 6 male & 5 Females) had improved balance. RESULTS: Pre exercise FR values in Males & Females were 12.7 & 11.41 Resp. While post exercises FR values in Males & Females were 14.6 & 12.66 Resp. CONCLUSION: From this study it was found that males have more improvement in balance than females after exercises. To improve balance, Not only balance exercises but the exercises for flexibility are also important. KEY WORDS- Osteoarthritis, Functional reach test. EMAIL: [email protected]


COMMUNITY BASED REHABILIATION

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PLATFORM PAPERS


ABSTRACT NO 50 (CBR 2)

LUMBAR CURVATURE AND PELVIC TILT DURING ADVANCED PREGNANCY

Dr Madhura M Inamdar 1, Dr Bharati Bellare 2

1: MAEER’S Physiotherapy College, Talegaon- Dabhade, Pune 2: Department of Physiotherapy, L. T. M. Medical College, Sion, Mumbai

AIMS & OBJECTIVES: 1) To compare Lumbar Lordosis angle between primigravid and nulliparous subjects. 2) To compare Pelvic Inclination between primigravid and nulliparous subjects. 3) To find correlation between Lumbar Lordosis Angle and Pelvic Inclination. PURPOSE OF STUDY: Literature on pregnancy related postural alignment and spinal curvature in sagittal plane has been inconclusive and shows variable results. This study is aimed since Indian data in the same is not available. METHODOLOGY: a) Study Design: Case control study b) Sample Size: 200. Study Group: Primigravid women in third trimester of pregnancy (n= 100,) Control Group: Healthy adult women (n=100) c) Sampling Technique: Sample of Convenience. d) Inclusion Criteria: - Healthy primigravid women in third trimester of pregnancy, Age 18 – 25 years. Exclusion Criteria: - Multigravida, Primigravida in 1st and 2nd trimester of pregnancy, Any known spinal pathology, Limb length discrepancy, History of injury to back before or during pregnancy. e) Outcome Measures: - Lumbar lordosis angle, Pelvic Inclination measured using Pelvic Inclinometer. f) Data collection and analysis: In bare foot relaxed standing, Lumbar Lordosis Angle was measured using Flexirular and Pelvic Inclination was measured using Pelvic Inclinometer.

Data analysis: Unpaired‘t’ test was used to compare Lumbar Lordosis Angle and Pelvic inclination between Study and control group. Pearson Correlation Coefficient was used to find correlation between Lumbar Lordosis Angle and Pelvic Inclination in both groups. RESULTS: The Mean Age of Study group was 21.61 +/- 2.29 years and for Control group was 22.07 +/- 2.41 years and the comparison showed non-significant difference ( p < 0.05 ). Mean Lumbar Lordosis

Angle was 37.75 +/- 12.87° in Study group and 44.88 +/ - 12.36° in Control group which on comparison using ANOVA showed significant decrease (flattening) in Study group. (p< 0.0001).

Mean Pelvic Inclination was 3.34 +/- 2.57° in Study group and 5.14 +/- 2.82° in Control group which on comparison using ANOVA showed significant decreased pelvic Inclination in study group. (p<0.0000). Both Study group and Control group showed Positive correlation between Lumbar Lordosis Angle and Pelvic Inclination (Pearson Correlation Coefficient r=0.6), which was significant statistically. (p<0.05) CONCLUSION AND CLINICAL SIGNIFICANCE: Study showed significant flattening of Lumbar Lordosis Angle and significant decrease in Pelvic Inclination in Pregnant females. The assumption of increased spinal curvature as pregnancy progresses in all women is not true. It is therefore essential that each woman should be assessed individually for her postural changes during pregnancy before prescribing Antenatal physiotherapy. KEY WORDS: Lumbar Lordosis angle, Pelvic inclination, Pregnancy EMAIL: [email protected]



COMPARISON OF ANKLE PROPRIOCEPTION BETWEEN PREGNANT AND NON PREGNANT WOMEN

Preetha R 1, John Solomon M 2, Parvathi V Bhat3

1. Department of Physiotherapy, MCOAHS, Manipal University

2. Department of Physiotherapy, MCOAHS, Manipal University

3. Department of OBG, TMA Pai Udupi Hospital

PURPOSE: Pregnant women report falls especially during their third trimester. Physiological changes along with ligament laxity can affect the proprioception in this population. Foot and ankle is the major structure that undergoes changes during pregnancy but the loss of proprioception in them has not been studied. Hence we aimed at comparing the ankle joint proprioception sense between the pregnant and non pregnant women OBJECTIVE: To compare the ankle repositioning error between pregnant and non pregnant women. METHODOLOGY: Study design: cross-sectional study design Sample size: 30 in each group Sampling: convenience sampling Inclusion criteria: primigravidae between age group of 18 to 35 Exclusion criteria:

• Subjects with any neurological abnormalities affecting the sensation

• Excessive pedal edema

• Any deformities or contractures of the feet

• Previous history of recurrent ankle sprain

PROCEDURE: 30 pregnant and 30 non pregnant women were included in the study. The subjects were asked to sit in the high sitting position with the feet hanging. The therapist moved the ankle into dorsiflexion and plantar flexion and stopped in between the two positions. The subjects were asked to feel the position and remember it. A digital camera was placed two feet away from the feet on a foot stool perpendicular to the ankle. The target angle was photographed. They were then asked to move the ankle a few times and then reposition the ankle in the target angle. This position was again photographed. Image tool software version 3.0.was used to measure the difference between the initial and the final angle. The difference in the initial and final angle (reposition error) was taken for analysis. DATA ANALYSIS: The statistical differences between pregnant and control subjects were determined using Mann Whitney U test with a 95% confidence interval. RESULTS: The mean repositioning error in the pregnant group was 11.4 degrees and the mean repositioning error in the non-pregnant group was 4.6 degrees. The difference between the group was statistically significant p=0.002 CONCLUSION: There is a significant difference in joint proprioception between pregnant and non pregnant women. This substantiates the need for further analysis for its contribution to balance and gait. KEY WORDS: Pregnancy, ankle proprioception, repositioning error, women’s health EMAIL: [email protected]



COMPARATIVE STUDY OF HIGH INTENSITY FUNCTIONAL EXERCISE PROGRAMME & CONVENTIONAL EXERCISE

PROGRAMME ON ACTIVITIES OF DAILY LIVING IN ELDERLY INDIVIDUALS

Dr. Shyam Ganvir

PDVVPFs College of Physiotherapy Ahmednagar. AIM: To find out if there exists any significant difference between high intensity functional exercise programme & conventional exercise programme on activities of daily living in elderly individuals. PURPOSE: To check the hypothesis that exercise programme would reduce dependency in self care & mobility from a short & long term perspective in elderly individuals dependent in ADLs & to determine the effect of dementia in achieving the desired results. METHODOLOGY : Study design: stratified cluster Randomised controlled trial Study population & sample size: Sampling technique : purposive sampling Inclusion criteria: participants were age 65 and older, dependent on assistance from a person in one or more personal ADLs according to the Katz Index,30 ability to stand up from a chair with armrests with help from no more than one person, a Mini-Mental State Examination (MMSE)31 score of 10 or more, Exclusion criteria: medically unstable , not willing to participate , non ambulatory Intervention a high-intensity functional weight bearing exercise program or a control activity consisting of 29 sessions over 3 months. Outcome measure : Barthel Index Data analysis: the effect on each item of the Barthel Index was evaluated using logistic regression (improvement or unchanged score vs deterioration) with the same independent variables as in the ANCOVA analyzing between-group differences in the total score. RESULTS When all participants were analyzed, there were no statistically significant differences in the total Barthel Index score between the groups at the 3- and 6-month follow-upsThe between-group analyses of people with dementia showed a significant difference in the total score (mean difference 1.1, P5.03) in favor of the exercise group at the 3-month follow-up, but the difference was not significant at the 6-month follow-up. DISCUSSION : The long-term effect found for all these outcome measures indicates that people in the exercise group continued to use their improved physical capacity in daily life after the 3-month exercise period. Maintaining independence in indoor mobility could be important for life satisfaction in this group of older people.6 Also, from a longer perspective, it could prevent further development of disability and diseases related to physical inactivity,13 because greater dependence in indoor mobility may reduce spontaneous physical activity. CONCLUSION: This study shows that a high-intensity functional weightbearing exercise intervention over a period of 3 months seems to have short- and long-term effects on maintaining indoor mobility in older people who are dependent in ADLs. KEY WORDS: elderly, high intensity exercise programe, ADLs. EMAIL ID: [email protected]



A STUDY ON ACCEPTANCE OF MODIFICATIONS IN HOMES OF THE GERIATRIC POPULATION

Dr. Ashutosh Kurtkoti 1, Dr. Tushar Palekar 2

1: CMF’s College of Physiotherapy, Nigdi, Pune 2: Padmashree Dr. D.Y. Patil College of Physiotherapy Pimpri, Pune

INTRODUCTION & PURPOSE: Older people are often not aware about the health care and lack scientific knowledge about the home modifications, rehabilitation and the place of living. So in order to study the basis geriatric problems with respect to their living place and the mentality of care givers for acceptance of home modifications, a specially designed study was needed. AIM: To assess the homes to find out environmental barriers and to check the readiness of the people to modify them OBJECTIVES: 1.To assess the homes of geriatrics for potential environmental barriers. 2. To suggest the home modifications and check readiness of the people for home modifications. 3. To check which the area is of home people are keener to modify to prevent falls. METHODOLOGY: Study design: descriptive study Sample population: geriatric people in PCMC area Sample size: 100 (50 first visit, 50 second visit) Sampling technique: simple random Inclusion criteria: healthy elders living in homes with family Outcome measure: pre & post questionnaire survey Survey was done in living room, bed room, kitchen, bathroom, and stairs of house, then questionnaire based assessment was done & required modifications were suggested, in the second visit it was checked whether the people have done the modifications or not & which is the most common area of the house for barriers, and people are keener to modify. RESULT: The data was analyzed using descriptive statistics at Level of significance ( α ) 5 % ( p value 0.05) & Degree of freedom 1. Out of 50, 40 homes have done suggested home modifications i.e. 80% and 10 homes have not done home modifications i.e. 20 %, Maximum people have done modifications in toilet/bathroom (24%) followed by living room (21%), stairs (20%), kitchen (19%) and bedroom (16%). CONCLUSION: People have willingness to do home modifications. Bathroom/toilet is found to be the most concerned area of home where maximum home barriers are found and modifications are done. CLINICAL SIGNIFICANCE: We can check the home hazards & suggest appropriate modification so that rehabilitation will have a clinical along with an added community level approach. KEYWORDS: Geriatrics, Home modifications, Home hazards/barriers E-MAIL: [email protected]



EVALUTION OF THE FUNCTIONAL REACH TEST IN

COMMUNITY-DEWELLING INDIVIDUALS FROM AGE GROUP 20-70 YEARS (A PILOT STUDY)

Triveni Shetty 1, Mrs Suneeti Chattergy

1: TNMC Medical College 2: A.I.I.P.M.R, Haji Ali, Mumbai.

AIM: Evaluation of functional reach test by taking into account the translation of different components i.e. finger, acromiom, hip, knee and ankle in various age groups. OBJECTIVE: To understand the effect of these translations on functional reach and To evaluate the change in the translation of these components with advancing age. METHOD: 1. STUDY DESIGN: Cross Sectional Study 2. SAMPLE POPULATION: 107 community dwelling individuals with 55 males and

52 females divided in 5 age groups ranging from 20-70 years. 3. SAMPLE TECHNIQUE: simple random. 4. OUTCOME MEASURE: Forward reach distance is in cms, conventionally recorded

by forward translation of finger in standing position. To know the translation of various body segments while performing the test-trunk,hip, kneee and ankle –instrumentation was structured to clinically measure the translations segment wise. Simultaneously foot pressure variation was recorded from initial position i.e. standing, throughout the test till final position of forward reach using FMAT software.

5. METHOD OF DATA COLLECTION & STATISTICAL TEST USED FOR DATA ANALYSIS: Data obtained was divide in 5 groups with 10 years interval. Comparison was made using analysis of variance and correlated using Pearson’s correlation.

RESULTS: The mean translation of all the components reduced from the age of 40 years onwards. Mean translation of the finger component( in the group 20-29 was 35.38 +5.246 cms) which is generally taken as the given value for functional reach showed significant reduction only after the age of 60 years.(26.07 +4.77). However the mean translation of the hip component reduced with advancing age with significant reduction after the age of 50 years(-3.14+ 4.4), and reversal of direction of translation i.e. use of hip strategy as a compensation to reach the mean functional reach distance. FMAT (foot pressure distribution) data suggested that the extent of weight shift also reduces with advancing age, with significant reduction seen only after the age of 50 years thus confirming the finding. CONCLUSION:: With advancing age the functional reach distance reduced with 80% of individuals using hip strategy to reach forward ,after the age of 50 years. After the age of 60 years, 95% of the individuals used hip strategy for reaching forward. The 20% individuals in the age group of 50-59 years and 5% of the individuals in the age group of 60-70 years maintained a forward translation of the hip ,knee and ankle component (though reduced) by going on walks for minimum 30 minutes /day thus maintaining an active life style could prolong the appearance of hip strategy in the older individuals KEYWORDS: Functional reach test, Translation of body segments stragey EMAIL ID: [email protected], [email protected]



PREVALENCE OF DIASTASIS RECTI ABDOMINIS (DRA) IN POST-PARTUM PERIOD - A CROSS SECTIONAL STUDY IN

UDUPI DISTRICT, KARNATAKA

Mishra N, Maiya G A, R Preetha

Department Of Physiotherapy, Manipal College Of Allied Health Sciences,

Manipal University, Manipal AIMS & OBJECTIVES: To find out the prevalence of Diastasis recti abdominis above and below the umbilicus in the post- partum period in udupi district. METHODOLOGY: Study Design: Cross - Sectional study Sample Population & Sample size : 48 post partum women Sampling Technique : Convenience Sampling Inclusion criteria : All post partum women between age group of 20-40 years (Spontaneous Vaginal Deliveries and Lower Segment Caesarean Sections). Exclusion criteria : Post-partum complications not recommended for the assessment of diastasis rectus abdominis. Procedure: The presence of Diastasis Rectus Abdominis was checked on the 2nd post natal day and 4th post natal day, for spontaneous vaginal deliveries whereas 3rd and 5th post operative day for Caesarean Sections using Noble’s criteria. Outcome measures: Prevalence of diastasis rectus abdominis in the post partum period using descriptive statistics. RESULTS: Out of total 48 subjects, Caesarean sections were done in 29(60.42%) of patients and 19(39.6%) underwent spontaneous vaginal deliveries. Diastasis rectus abdominis at 3rd post operative day was present in 44.82 % of caesarean sections. Out of these subjects, all had diastasis at umbilical level (100%), 76.92% had above umbilicus and 23% had below the umbilicus. Diastasis at 5th post operative day was present in 44.82% out of the 29. At the umbilical level it was present in 76.92% , above the umbilicus in 69.2% and below the umbilicus in 23% of caesarean sections. Out of the 19 who had vaginal delivery, diastasis recti abdominis was present in 5 (26.3%) subjects and absent in 14 (73.68%). At the 2nd post natal day, out of those five, all had diastasis at umbilical level (100% ), 80% had above the umbilical level and none of them had below the umbilical level. On 4th post natal day, 60% of patients had diastasis at the umbilicus and 40% had above the umbilicus. CONCLUSION: The prevalence of diastasis rectus abdominis was higher at the umbilical level and above it, in subjects who underwent caesarean sections as compared to the vaginal deliveries. CLINICAL SIGNIFICANCE: Diastasis is more prevalent in women who underwent Caesarean sections. Therefore, early post natal physiotherapy is required to prevent or treat the complications. KEYWORDS: Prevalence rate, DRA, post partum period, Noble’s criteria EMAIL : [email protected]



ANALYSIS OF WORK-RELATED HEALTH PROBLEMS IN BEST BUS DRIVERS-CROSS- SECTIONAL STUDY

Dipti B Geete1, Bhavana S Mhatre 1, Amita A Mehta 1, Madhavi V Lokhande

1: P.T. School & Centre & G.S.M.C & K.E.M.H.


AIM : Analysis of Work – related health problems in BEST bus drivers. OBJECTIVES:- 1. To find out the prevalence of musculoskeletal problems in bus drivers. 2. Work-station evaluation for analysis of risk factors related to Musculoskeletal problems. METHODOLOGY:- Study Design: - Cross- sectional study. In order to estimate occupational risk factors among the bus drivers survey was carried out on BEST bus drivers in BEST bus depot,Shivari Mumbai. 60 bus drivers were interviewed. A Questionnaire was formed on the basis of Job Demand Analysis, Task Analysis & Ergonomic Evaluation. Questions included were 1.Age 2. Musculoskeletal related problems 3.Occupational related issues 4.Personal Health habits- addictions, exercises. A result was analysed using logistic regression model. RESULTS:- Out of the 60 bus drivers, 80% drivers reported back pain, 45% reported neck & Knee pain & 30% heel & wrist pain.100% drivers were getting affected due to vibration & noise pollution, eye irritation. 60% drivers were feeling fatigue after 7hrs of duty. CONCLUSION:- The prevalence of Low back pain in bus drivers was 80%. The Job Demand analysis & Ergonomic Evaluation shows the working load & working environment like faulty work-station architecture ,long working hours, sitting posture for prolong period during working hours ,inadequate rest pause , continuous exposure to vibration leads to multiple musculoskeletal problems. CLINICAL SIGNIFICANCE:- Optimum Work-Station design is key factor to prevent potential musculoskeletal problems in bus drivers. Thus it is essential part of preventive strategies. KEY WORDS:- Cross-Sectional study, Job Analysis, Risk factors, Bus drivers. EMAIL ADDRESS:- [email protected]



EFFECT OF AEROBIC EXERCISE PROGRAM ON HEALTH RELATED QUALITY OF LIFE AND PHYSICAL PERFORMANCE

IN OVERWEIGHT AND OBESE WOMEN- A 1 YEAR FOLLOW-UP STUDY

Swati M. Surkar, Amita Mehta, Pallavi V.Wange

P. T. School and Center, Seth G.S.M.C & K.E.M. Hospital

BACKGROUND: Obesity is a major health concern and a risk factor for several physical illnesses, functional limitations and poor quality of life. It may impact important aspects of health-related quality of life (HRQOL) such as physical health, emotional well-being, and psychosocial functioning. Obese and overweight person experience significant impairments in quality of life and decreased physical performance. PURPOSE OF THE STUDY: Effect of aerobic exercise on quality of life and its association with physical performance is not yet studied. AIMS AND OBJECTIVES: 1. To determine the effect of aerobic exercise program on health related quality of life. 2. To determine association of physical, emotional and psychosocial domains of health related quality of life (HRQOL) with physical performance and body mass index (BMI) Methodology: a) Study design: Experimental study b) Sample size: 40 females c) Inclusion criteria: Overweight and obese females (BMI >24.9) Exclusion criteria: females with known cardio respiratory, psychiatric and severe musculoskeletal disorders d) Outcome measures: 1.To assess health related Quality of Life: SF-36

2. To assess physical performance: Queens’ college step test 3. Body Mass Index

e) Data collection: 40 females were selected prospectively based on the selection criteria from obesity clinic, P.T. School and center, Seth GSMC and KEM Hospital, Mumbai. SF 36 and Queens’ college step test was administered. Supervised aerobic exercise program for 1 year was given. Statistical analysis: Wilcoxon Signed Rank Test and Multivariate linear regression analysis RESULTS: Mean weight loss was 6 + 2 kg after 1 year of aerobic exercise program. At the baseline mean scores of HRQOL were low which improved significantly p<0.005 after 1 year of treatment program. A >10% weight loss at the end of one year was associated with improvement in obesity related physical functioning, emotional well being and general health. Linear regression analysis revealed that higher BMI, less scores on HRQOL negatively predicted the physical performance. CONCLUSION AND CLINICAL SIGNIFICANCE: Aerobic exercise program improves the HRQOL and physical performance in overweight and obese females. Higher BMI and lower scores on HRQOL are associated with poor physical performance in obese females. KEY WORDS: Health related Quality of Life, physical performance, aerobic exercise program EMAIL: [email protected]


COMMUNITY BASED REHABILIATION

SECTION

DIGITAL PAPERS



AWARENESS FOR THE NEED OF ADOLESCENT FRIENDLY HEALTH SERVICES IN STUDENTS: A PRE & POST QUESTIONNAIRE BASED

SURVEY

Swati Meshram 1, Gayatri Nagpure 2 1: Terna P.T. College, Nerul, Navi Mumbai

2: Ex-Asst.Prof Dept.Of Obs/Gynecology .Sawangi, Wardha.

BACKGROUND: Adolescent Population in India around forms 1 heterogeneous group of 250-260 million working in vulnerable situations prone for sexual abuse. A present trend in the society is early biological maturation & letter socioeconomic independence. We felt a need to bring them together, evoking queries on their needs, followed by problem solving for body image, sexual development, & develop moral attitudes AIM: To attain & provide realistic solutions to the medical & paramedical students through problem solving approach for current problems in physical, social, environmental domain in them. OBJECTIVES: To educate the students in medical& Para-medical profession who are the future health providers in society. To train them with an aim to send mini messengers in society so that advantage of resources can be taken within appropriate time by their peers & health seekers. Study design: pre & post questionnaire based survey. Eligibility criteria: students in the age group of 18-23 years who volunteered to attend the workshop & participant in the study. Study population: volunteers included 300 medical, 250 dental, 250 physiotherapy students. Procedure: a ready to use questionnaire advocated by who was modified (24 items) & administered pre & post workshop to the participants. This was validated amongst the staff prior to administration. Final questionnaire intend to retrieve the participants idea about following issues such as their idea of adolescence, implication on health, gender specific sex related issue, resources for information used by them, importance on nutrition adolescence health, sexually transmitted diseases, prevention & moral conduct. Workshop content was as follows: 2days interactive session in which group activities & role plays were included & administration of questionnaire pre & post workshop. Data was collected from questionnaire & analyzed as proportion. RESULTS: certain important findings are included. 57% knew about adolescence definition, 72% agreed to invest in Adolescent health, 57% knew about RTI/STI & HIV/AIDS, 80% were aware about contraception CONCLUSION: There is need to use adolescent friendly health services to cope up with daily life situations, inculcate healthy habits and life styles, grow into healthy adults, increase productivity, averting future health costs, to reduce morbidity & mortality in adolescents, to reduce sexual transmitted disease epidemic like HIV & Syphilis epidemic,& finally health is their Human right. There is a need of universal awareness & sensitization about adolescent health, & establishment of Adolescent Friendly health Clinics. KEY WORDS: adolescents related issues, problem solving, and adolescent friendly health services EMAIL: [email protected]



EFFECTS OF CONBINED RESISTANCE AND HOME-BOUND

WALKING EXERCISES ON GLUCOSE CONTROL , LIPID PROFILE AND QUALITY OF LIFE IN TYPE 2 DIABETIC

PATIENTS

BIJAL CHETAN CHAMPANERIA, DR. SHRADDHA DIWAN S.B.B. COLLEGE OF PHYSIOTHERAPY IN V.S GENERAL HOSPITAL,

AHMEDABAD AIM : To evaluate combined resistance and home bound walking program in type 2 diabetes mellitus patients. OBJECTIVES: According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 40 million persons with diabetes in India in 2007 and this number is predicted to rise almost 70 million people by 2025.Type 2 Diabetes may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance. There is metabolic effects, such as abnormal lipid profile, increased blood glucose level. Physical activity including appropriate endurance and resistance training is a major therapeutic modality for type 2 DM. So the purpose of the study is to evaluate effect of combined resistance and home bound walking exercise on glucose control ,lipid profile and quality of life in type 2 DM patients. METHODOLOGY:

a) Study design: Experimental study b) Sample population and sample size: 50 patients.25 patients in experimental

and 25 in control group. c) Sampling Technique: Simple random d) Inclusion criteria: Type 2 DM with age < 65 years., Exclusion criteria: taking

oral hypoglycemic drugs, chronic alcohol use, smoking, H/o CAD, renal impairment, hepatic impairment, hyperuricemia, uncontrolled hypertension. SBP>160mm Hg., diabetec neuropathy, taking insulin, diuretics, antidepressants .

e) Outcome measures: blood glucose level, lipid profile and quality of life by SF 36.

f) Data collection and analysis: Data collected randomly from V.S.G.H. Diabetes OPD. After normalizing data t test used. Statistical analysis done with the use of graph pad prism version 5.02

RESULTS: Statistical significant :Pre & post exercise fasting blood glucose level( P :0.0353)Pre ex. group Mean: 41.07±5.121,post ex.group mean:27.11±3.916 and diff. between mean: 13.96±6.447 & Scores of physical role(P:0.00061)Diff.bet.mean:2.164±7.652,Pain(P<0.0001)Mean: 61.32±7.843,Mental Health(P:0.0010)Mean: -24.88±7.117. CONCLUSION AND CLINICAL SIGNIFICANCE:Significant difference observed between pre and post exercise fasting blood glucose level and scores of physical role,pain and mental health & no significant diff.observed in the BMI, Total cholesterol,hdl-c,ldl-c,tg and scores of physical function,vitality,social function & general health. So,Combined resistance and home bound walking programme helps in reducing blood glucose level and improving quality of life. KEY WORDS: Type 2 diabetes, resistance training, Home bound walking EMAIL ID: [email protected]



VELOCITY OF MOVEMENT DURING ANKLE STRENGTH AND

POWER TRAINING WITH ELASTIC RESISTANCE BANDS IN

COMMUNITY DWELLING OLDER ADULTS

Pavithra Rajan, Dr. Michelle Porter Faculty of Kinesiology and Recreation Management, University of Manitoba,

Winnipeg, Canada AIM: The aim was to examine the differences in the training velocities for strength and power training of the ankle using elastic resistance bands, in community dwelling older adults, and to quantify full range of training velocities. OBJECTIVE: The objective was to determine the velocity at which movement occurs during training. METHOD: a) Study design : Quantitative within-group b) Sample population: Community dwelling older adults c) Sampling method/technique which you used for sample collection:

Simple random sampling (n=10) d) Outcome Measure: The primary outcome variable will be ankle training velocity

(degrees per second) for dorsiflexion and plantar flexion. e) Method of data collection and statistical test used for data analysis

Patients were eligible if they were 65 years and older, and attending the Day Hospital for at least 6 weeks at the Physical Therapy Department at a local health centre in Winnipeg, Canada. Exclusion criteria were: cognitive impairment, medical conditions precluding ankle exercises, neuromuscular diseases affecting movement control, and those who have already attended ankle resistance training program once a week for more than 6 months. Potential subjects were approached by the Hospital staff and only those interested in the study were given packages containing invitation letters, a consent form and a general information questionnaire. Once interested individuals contacted the researchers and a screening questionnaire was used to determine who was eligible to participate in the study. During the first exercise session, dorsiflexor strength was measured using a hand held dynamometer (MicroFet2 MT R, Hoggan Health Industries) over 3 maximal contractions, and strength and power training familiarization exercises for the ankle were performed using elastic resistance bands. From sessions 2 to 6, dorsiflexor and plantar flexor strength and power training, 8 repetitions each, against elastic resistance will be performed. Only the dominant leg will be filmed using a Canon Optura 200 MC mini digital camcorder. Data analyses will be done using Sigma Plot and SPSS (Statistical Program for Social Sciences) software. Paired t-tests will be used to determine if there are differences in strength and power training velocities.

RESULTS: This study is ongoing and hence no results will be presented. CLINICAL SIGNIFICANCE: This study could emphasize the differing training velocities that occur with power training and strength training in community dwelling older adults. In addition, it will determine what potential older adults have for performing very fast contractions during power training. EMAIL: [email protected]



GROUP VERSUS INDIVIDUAL PHYSIOTHERAPY SESSIONS FOR FEMALE URINARY STRESS INCONTINENCE –

A RANDOMISED CONTROLLED TRIAL

Komal Soni 1, Dharti Hingrajia 2, Harshit Soni 2

1: Bombay Maternity and Surgical Hospital, Surat. 2: South Gujarat Medical Education and Research Center,

Surat People’s Bank Physiotherapy College, Surat. AIMS, OBJECTIVES AND PURPOSE OF THE STUDY: Physiotherapy in the treatment of Urinary Stress Incontinence (USI) has been effectively used since 1948. It can be given as a ‘Group therapy’ or an ‘Individual therapy’. Despite this there have been few Randomized Control Trials comparing the effectiveness of Group against Individual therapy. The purpose of this study was to compare the effects of Group and Individual Physiotherapy sessions on the severity of incontinence & quality of life (QoL) in patients with USI. METHODOLOGY: Study Design : Experimental Sample Population and Sample Size: 30 women with chronic USI from the age group of 30 to 55 (Mean age 42.16) years. Sampling Technique: Simple Randomized sampling to divide the population in two groups: Group therapy (n=20) and Individual therapy (n=10). Inclusion Criteria: Females with a history of chronic (2-5 years) USI, between age group of 30 to 55 years who underwent full-term vaginal delivery. Exclusion Criteria: Females having pregnancy, who participated in Physiotherapy for USI in the last year, having history of neurological and psychiatric diseases, pelvic malignancy or surgery, vaginal or bladder prolapse. Outcome Measures: Visual Analogue Scale (VAS) and KING’S Health Questionnaire (KHQ) for severity and QoL in USI respectively. Data Collection: Patient’s were asked to mark on VAS and fill up the KHQ at baseline & once again after 3 months of Physiotherapy in form of pelvic floor muscle exercises. Data Analysis: Two-tailed unpaired t-test was measured at 0.01 level of significance by SPSS13.0 version to compare post-intervention differences between to groups at n1+n2-2 degree of freedom. RESULT: The reduction in severity of incontinence (VAS) for Group therapy was 1.94±0.43 and for Individual therapy was 2.02±0.46 and ‘t’cal value was 0.463. The improvement in QoL (KHQ) for Group therapy was 30.09±05.30 and for Individual therapy was 21.51±06.73 and ‘t’cal value was -1.63. CONCLUSION: Both Group & Individual Physiotherapy for female USI are equally effective for improvement in severity of incontinence & QoL. CLINICAL SIGNIFICANCE: From present study we concluded that both Group and Individual therapy are equally effective in USI, so one may use any one of it to gain benefit. Moreover Group therapy being more cost effective, time saving and more beneficial in enhancing motivation, relaxation and enthusiasm for subjects, it may be a more convenient option. KEY WORDS: Urinary Stress Incontinence, Group Versus Individual Physiotherapy, Severity, Quality of life. E-MAIL: [email protected]



EFFECT OF ERGONOMIC AND PHYSIOTHERAPEUTIC INTERVENTION ON UPPER EXTREMITY WORK RELATED

MUSCULOSKELETAL DISORDERS- A SYSTEMATIC REVIEW

Prakruti J Patel, Neha Reji, Shilpi Jasrotia, Dr. Kavitha Raja Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal

BACKGROUND: Increasing attention is being paid towards prevention and treatment of work-related upper limb disorder (WRULD). Ergonomics and physiotherapy interventions are play a major role in treatment of these disorders. OBJECTIVES: To review the literature between 2000- 2010 on effectiveness of 1. Ergonomic programs on work- related upper limb disorders (WRULD) against no

treatment 2. Physiotherapy intervention against no or placebo treatment on WRULD 3. Combination of ergonomics and physiotherapy intervention on WRULD METHODS: Study Design: Systematic review Search Strategy: All full text, randomized controlled trials and case control trials in the English language between 2000- 2010 were searched using 1. Search engines: Pubmed, CINHAL, ProQuest, OvidSP, Iowa, ScienceDirect and

Cochrane 2. Keywords: ergonomics, exercise, work place, work- related, physiotherapy ,

physical agents, work- related musculoskeletal disorders, interventions 3. BOOLEAN terms: AND / OR Selection Criteria All randomized controlled trials and case control trials studying the effect of conservative treatment on work- related upper limb disorders. Conservative treatment may include work place modifications, exercises, physical agents, and biofeedback Data Collection & Analysis Three reviewers independently selected the articles and assessed the clinical relevance and methodological quality using the Structured Effectiveness Quality evaluation Scale (SEQeS). Due to heterogeneity of the outcome measures, pooling of data was not performed. RESULTS: Nineteen articles involving 2557 subjects were included. Ten articles studied the effect of ergonomics, 3 on the effects of physiotherapy and 6 studied the combined effects of ergonomics and exercise. The primary outcomes assessed were pain, sick leave, health related quality of life, frequency of symptoms and the neck pain and disability index. Interventions used in these studies included furniture / device design modification, ergonomic training, stretching exercises, resistance training, neck muscle endurance training and myofeedback. CONCLUSION: Ergonomic modifications such as forearm boards, adjustable chairs and individualized work stations prove to be effective in reducing neck and shoulder symptoms. Evidence on physiotherapy interventions is inconclusive. There is insufficient good quality evidence to make recommendations on the combined effect of ergonomic and physiotherapy interventions. KEY WORDS: workplace, modification, musculoskeletal disorders, exercise EMAIL: [email protected]



AWARENESS OF POST POLIO SYNDROME IN MEDICAL

PRACTITIONERS IN AHMEDABAD – A CROSS-SECTIONAL SURVEY STUDY

Rajesh Jadav, Dr. Megha Sheth, Dr.Neeta Vyas S.B.B College of Physiotherapy, Ahmedabad

OBJECTIVE : To determine percentile of awareness in medical practitioners for post polio syndrome PURPOSE: Post Polio Syndrome(PPS) is a condition that affects polio survivors from an initial acute attack of the poliomyelitis virus. Post polio syndrome is mainly characterized by new weakening in muscle that were previously affected by the polio infection and in muscles that seemingly were unaffected. India would have one of the largest numbers of polio survivors in the world with new cases still being diagnosed- more than 80 lakh people have been affected by polio paralysis in the past years. 24% survivors in USA suffer from PPS. 85% survivors complained of new health problems. But contribution to post polio syndrome is less from India. So, the question arises whether patients and medical practitioners are aware about the condition or not. So the need of the study about awareness of post polio syndrome in medical practitioners METHODOLOGY: Study design - Cross – sectional survey Sample size and population- 50 Institutional and private practitioners Sampling Technique- Random Sampling INCLUSION CRITERIA- Physicians, Neuro physicians, orthopedic surgeons, physiotherapists, psychiatrists, prosthetists and orthoticists Exclusion criteria: Oher fields of medical practice Outcome Measure: Questionairre Data Collection and Analysis: A self administered questionnaire concerning their profile and close ended questions was filled by 50 medical practitioners from different hospitals and clinics in Ahmedabad region in Gujarat, India. Questions were regarding cause, symptoms, management of PPS. Doctors gave an answer as yes or no. Collected Data was analyzed, that gave a brief idea of awareness of post-polio syndrome in medical practitioners in Ahmedabad, Gujarat RESULT: 75% of Orthopedics, 74% General Practitioners, 80%Neurologists, 25%Physiotherapists and 50%Psychiatrists were aware of Post Polio Syndrome. Percentage of awareness and existence of condition was 60.8% which is high. However awareness of clinical features and appropriate management was 48% which is low. CONCLUSION : Awareness about PPS exists more among orthopaedicians and neurologists compared to others. However awareness of diagnositic criteria and management is low. CLINICAL SIGNIFICANCE: There is a need to promote awareness about Post polio Syndrome in Ahmedabad, Gujarat. Awareness in India needs to be evaluated. Awareness of appropriate management solutions needs to be generated. KEY WORDS: Post Polio Syndrome, Awarenes, Medical Practioners E-MAIL ID: [email protected]



PREVALENCE OF OBESITY IN PERSON OVER 30 YEARS IN HIGH INCOME GROUP

Dr. Manisha Rathi

Padmashree Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune.

BACKGROUND: Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. Obesity has reached epidemic proportions in India in the 21st century, with morbid obesity affecting 5% of the country's population. Increasing awareness of obesity can prevent various complications in future hence this study will helps us finding the status of obesity and its risk factors. OBJECTIVES: 1) To find out the prevalence of obesity in both sexes in persons aged 30 years and above. 2) To determine the risk factors of the obesity in the study subjects. MATERIALS AND METHODS: This cross sectional study had been undertaken in literate high income group from the Pimpri area in which persons aged 30 years and above, in a family, were interviewed. A house-to-house survey method on pre-designed, pre- tested structured questionnaire was used. Information regarding socio-demographic profile and current health status were recorded. Anthropometric data regarding height, weight, girth at hip and waist were also measured. BMI was calculated and categorized as per Indian standards. The data was collected and analyzed using statistical software and proportional statistical test were applied. RESULTS: The study showed that 39.7% of males and 36.6 % of females, both aged 30years and above were either obese or over weight. 40.5% males and 38.9% females showed moderate to high risk of cardiovascular diseases. Other morbidities were also noted. CONCLUSIONS: It can be concluded from the present study that prevalence of obesity and overweight is high (38.6%). Early detection of it can prevent various complications associated with it with the help of BMI and waist circumference KEYWORDS: Body mass index, obesity, physical exercise, cardiovascular risk EMAIL: [email protected]



EFFECTIVENESS OF THE EXERCISES ON PRIMARY DYSMENORRHOEA IN COLLEGE-AGED FEMALES

Dr.Mansi Pandit, Dr. Anand Misra

Department of Physiotherapy, Indore Institute of Medical Sciences, Indore

BACKGROUND & PURPOSE: Primary Dysmenorrhoea is one of the common gynaecological complaints in female adolescents, and is the leading cause of periodic/college absenteeism; and reduced quality of life in women. It is usually defined as cramping pain in lower abdomen occurring at the onset of menstruation in the absence of any identifiable pelvic disease. A relative lack of awareness of the very high rates of prevalence and the substantial morbidity of Primary Dysmenorrhoea; often leads to inadequate treatment of this problem. Limited researches have been made with regard to physical exercise used as a therapeutic intervention in the treatment of Primary Dysmenorrhoea. The purpose of the study was to establish the effectiveness of exercise in the management of Primary Dysmenorrhoea. METHODOLOGY:

a) STUDY DESIGN: A randomized clinical trial with two groups of different subjects was used.

b) SAMPLE POPULATION: 60 subjects between the age of 18-26 years identified with primary dysmenorrhea were selected on the basis of the inclusion criteria.

c) INCLUSION CRITERIA:

• College girls between the ages of 18-26 years.

• Marital status should be unmarried.

• Should have a regular menstrual cycle every month. d) EXCLUSION CRITERIA:

• Polycystic ovarian disease

• Should not have any chronic low back ache.

• Should not have any associated pelvic pathology (example: Pelvic inflammatory disease).

e) OUTCOME MEASURES: All the subjects were measured for pain by Visual Analogue Scale, and for quality of life by Short Form-36 health survey questionnaire

f) DATA COLLECTION AND ANALYSIS: Experimental group was under a structured 6 week exercise program; conducted for 45 minutes each day for 6 days a week. The control group had no follow up and continued their lifestyle. The data collected was statistically analyzed using the ‘z’ test.

RESULTS The results showed significant improvement in the experimental group in terms of pain reduction (p<0.05) and the quality of life (p<0.05) while, the control group showed no improvement overall. CONCLUSION: The results of the present study suggested that exercises are highly effective in reducing the painful symptoms of primary dysmenorrhoea, and also in the enhancement of the quality of life. Further trials should be conducted to confirm the results. KEY WORDS: Primary Dysmenorrhoea, Exercises. EMAIL: [email protected]



SYMPHYSIS PUBIS DYSFUNCTION DURING PREGNANCY- A MULTIMODALITY PHYSIOTHERAPEUTIC APPROACH

Arati Ramannavar 1, Dr.Shobhana Patted, MD 2

1: Institute of Physiotherapy, KLE University, Belgaum 2: Professor, Dept of OBG, KLE University, Belgaum.

AIMS AND OBJECTIVES: Symphysis Pubis Dysfunction (SPD) is a commonly associated complication of pregnancy and childbirth often neglected, characterized by stiffness or excessive movement of the symphysis pubis associated with pain centered on the joint at the front of the pelvis, possibly because of misalignment of the pelvis resulting in pain and functional limitation. The present study was aimed to evaluate the effect of a multimodality physiotherapeutic approach in pregnancy induced SPD. METHODOLOGY: Study design: Experimental study. Sample population: Pregnant women with clinical diagnosis of symphysis pubis dysfunction. Sample size: Twenty seven pregnant women with complaints of symphysis pubis pain. Sampling technique: Non-probability sampling/ Convenience sampling Inclusion criteria: i) The presence of pubic pain, which was defined as pain experienced between the inferior border of the pubic symphysis that started during pregnancy. ii) Pain that increased by position and locomotion. iii) Restriction of normal daily activities due to SPD. iv) Women who never received physiotherapy treatment for their presenting complaints during present pregnancy. v) Willingness of a woman to participate in the study or having a clear treatment preference. Exclusion criteria: i) Women treated with exercises for pelvic and low back pain during present pregnancy. ii) Women with organic pathology (such as nerve root pathology, rheumatoid disorders, TB spine). iii) Women with obstetric complication such as- haemodynamically significant heart disease, incompetent cervix/cerclage, multiple gestations at risk for premature labour, persistent second or third trimester bleeding, placenta praevia after 26 weeks gestation, pregnancy induced hypertension. (Absolute contraindications to exercise during pregnancy- American College of Obstetrics & Gynecology, 2002). Outcome measures: Visual analog scale (VAS) on 1st, 3rd and 5th day and modified oswestry disability questionnaire (MODQ) on 1st and 5th day respectively. Data collection: Data was collected at K.L.E’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India for a period of two years from October 2007 to October 2009. Physiotherapy intervention included cryotherapy, transcutaneous electric nerve stimulation, pelvic floor strengthening exercises, postural correction, ADL modification and stabilization of symphysis pubis by trochanteric belt for 5 days. ANALYSIS & RESULTS: Data was analyzed using Wilcoxon signed ranked test and z test. There was significant reduction in VAS scores on day 3 and day 5 (p=.000). MODQ scores significantly decreased on 5th day (p=0.000). CONCLUSION: A multimodality physiotherapeutic approach has shown to reduce pain and improve functional outcome in pregnancy induced SPD. KEY WORDS: SPD, Pregnancy, multimodality physiotherapy, VAS, MODQ.


MISCELLANEOUS SECTION

PLATFORM PAPERS


ABSTRACT NO 9 (MISC 3)

IDEAL ERGONOMICAL DESIGN FOR LIGHT HAND ACTIVITIES IN STANDING.

Dr. Manoj Agnihotri, Dr. Snehal Ghodey

Terna Physiotherapy College, Nerul, Navi Mumbai

AIM: To find out ideal ergonomic position for light hand work activities in standing. OBJECTIVES: 1. To find out the co-relation between person’s height and distance of the platform for performing hand activities in standing. 2. To find out the common area of pain for three different platforms for different distances. PURPOSE:The purpose of the study is to know whether hand activities which are involved in standing are causing any musculoskeletal discomfort or not. METHODOLOGY: STUDY DESIGN - Cross sectional study SAMPLE POPULATION- 100 Normal healthy population of both males & females of various age groups (young – adult i.e 25- 50 years ) of PCMC area was selected for the study. SAMPLING TECHNIQUE – Random sampling INCLUSION CRITERIA- Healthy subjects (both males & females ) between the age of 25-50 years are selected & divided in 4 groups: Group 1--- 135 to 150 cm. heighted people; Group 2--- 150 to 160 cm. heighted people; Group 3--- 160 to 170 cm. heighted people; Group 4--- 170 to 180 cm. heighted people. EXCLUSION CRITERIA – Acute injury to back, Infection (unhealed / healing), Congenital deformities, Spinal upper and lower limb deformities, Neurological deficit OUTCOME MEASURES - VAS, Timing, Repetitions and Area of pain DATA COLLECTION & ANALYSIS – ANOVA and POST HOC TEST is used for correlation between person’s height and distance of the platform for performing hand activities in standing. RESULTS -- a) Subjects in group 1,performed better at distance of 4 inch on 30 & 32 inch

platforms ( p values are 0.000 & 0.032 ) b) Subjects in group 2,performed better at distance of 4 inch on 32 inch platform ( p value 0.032 )

c) Subjects in group 3,performed better at distance of 4 inch on 32 & 34 inch platforms ( p values are 0.032 & 0.690 ) d) For 4th group people no platform was found to be comfortable.

CONCLUSION – The study concluded that, light handwork activities if performed at waist level and at nearest distance; activities can be performed comfortably without causing much of musculoskeletal discomfort. The commonest area of pain noticed was lowback pain. CLINICAL SIGNIFICANCE – The study can be implemented while designing a platform hand activities. The height of platform at which the activities are going to be performed should be at subject’s waist level. KEY WORDS - Ergonomical Design, Hand Activities, Pain, Repetitions EMAIL ADDRESS – [email protected], [email protected]



PHYSIOTHERAPY FOR IMPAIRMENT IN WALKING IN DOGS WITH HIND LEG INVOLVEMENT, PILOT STUDY.

Kshipra Joshi 1, Dr. Ganesh Pande 2, Dr. Milind Hatekar 3

1: Private practitioner, Prime Clinic

2: H.O.D. Rehabilitation Dept. B J Medical College and Sassoon General Hospitals, Pune 3: Veterinary Surgeon, Pune

INTRODUCTION: Animals, like humans, respond well to physiotherapy. Many animals require exercises to complete their rehabilitation, especially after surgery, neurological conditions and chronic musculoskeletal disorders. Though effects of physiotherapy are widely known in various animals, limited studies were found on functional independence in dogs. AIMS AND OBJECTIVES: To promote functional independence in dogs with hind limb impairments using physiotherapy interventions. METHODOLOGY: Study Design: EXPERIMENTAL pre-post within subject Sample Population: dogs with hind limb impairments. Sample Size: 16 dogs. Sampling Method: Convenient Sampling Inclusion Criteria: Dogs of any breed with difficulty in function due to hind limb impairment Exclusion Criteria: fore limbs involved. Outcome Measures: LAMENESS SCORE FUNCTIONAL EVALUATION PROCEDURE: On the reference from veterinary consultant and oral consent from the owners, history was taken and assessment was done in dogs based on lameness score and functional impairments. A combination of stretching, strengthening exercises and TENS was used in dogs. Treatment session was for a duration of 45mins given 5times/week and re-evaluated after 10 sessions. RESULT:

9/16 dogs progressed from 4 /4 – 0/4 on lameness score. 7/16 dogs progressed from 4/4 – 1/4 on lameness score Change in Functional independence was achieved in all dogs.

CONCLUSION AND CLINICAL SIGNIFICANCE: The study demonstrated a change in lameness score from 4/4/ to 0/4(average) and achievement of sit to stand, sit to down transitions, walking and sometimes running proves that physiotherapy interventions including stretching, strengthening and modalities like TENS are helpful in effective treatment of dogs. Physiotherapy techniques can be incorporated as an important part in treatment and recovery of animals. KEY WORDS: Animal physiotherapy, TENS EMAIL: [email protected]



EFFECT OF PROLONGED SITTING ON LUMBAR SPINE PROPRIOCEPTION

Dr Garima 1, Dr Sachin Sethi 2, Dr Reena Kumari 1

1: SBSPGI, Dehradun

2: Max Super specialty Hospital, Saket, Delhi OBJECTIVE: To determine the effect of prolonged sitting on lumbar proprioception by measuring the reposition error. AIMS: 1) To measure the lumbar proprioception in subjects prior to and after prolonged sitting. 2) To compare the difference in lumbar proprioception of the subjects after prolonged sitting and without prolonged sitting. Methodology: Experimental study with same subject design. Population consisted of 600 male students of SBSPGI. Out of this population 30 male subjects (mean age 21.16±1.39) were selected as per inclusion and exclusion criteria. Sampling technique was convenient random sampling. Inclusion criteria: Age 18-25 years, Subjects who have prolonged sitting job for atleast 3 hours, Male subjects Exclusion criteria: Any recent or past history of low back ache, spinal disorder, spinal surgery, H/o lower limb fracture, Vestibular disorder. Outcome measure: Reposition error (for lumbar proprioception) Instrument used: Gravitational inclinometers, stabilization belt. METHOD: The lumbar reposition error was checked on two different days. First day, the lumbar proprioception was checked twice at a difference of 3 hours without prolonged sitting. And on the second day, the lumbar proprioception was checked prior to and after 3 hours of prolonged sitting. Data analysis was done using paired t-test. (p value<0.05) RESULT: t value for control group (pre and post 3hrs) was 3.453 and for experimental group (pre and post 3 hrs) was 7.787. The t value for the control and experimental group (post and post 3 hrs) was 7.875. All the values were found to be significant. CONCLUSION: The study concluded that there was a more significant difference in lumbar reposition error in persons who sat for prolonged duration when compared with persons who do not sit for prolonged duration. CLINICAL SIGNIFICANCE: Prolonged sitting leads to lumbar paraspinal muscle fatigue which can impair the ability to sense the change in lumbar position. This may lead to low back pain due to which they have less ability to protect themselves from sudden loads during various activities of daily living. Thus frequent rest periods should be imparted for individuals who go for prolonged sitting. Ergonomic advices which include proper seat design should also be given to such individuals and postural re-education should form an integral part of the rehabilitation for individuals suffering from low back pain due to prolonged sitting. Keywords: prolonged sitting, proprioception, inclinometer, reposition error. EMAIL: [email protected], [email protected]



PREDICITVE VALIDITY OF TIMED UP & GO TEST.

Dr. Abhijit Diwate PDVVPF’s College of Physiotherapy, Ahmednagar

PURPOSE: Falls is a major concern to every elderly. The main purpose of Timed Up and Go Test (TUGT) is to identify potential fallers. Previous research has validated the use of the TUGT to identify those who have previously fallen. However, the test has not yet been validated in its ability to predict falls. AIM : To determine predictive validity of Timed up & Go test in terms of cut off time above which the elderly individuals are likely to fall. METHODOLOGY: Study design : Observational study. Subjects: Subjects were 100 elderly individuals over the age of 65 years . inclusion criteria: They demonstrated an ability to walk for six meters with or without an assistive device and to follow directions. PROCEDURE: The TUGT was administered as part of a larger study to assess efficacy of a new Fall Risk Screen. The screen consisted of questions related to risk factors including previous falls, and the TUGT. Participants were administered the TUGT only once, unless instructions were misunderstood, in which case the time from a second trial was used. Following screen administration, subjects were called approximately every 3 months during the following year and asked about any falls or steps taken to prevent falls. Data analysis: T-tests were performed to determine whether differences existed between mean TUGT times, and receiver operating characteristic (ROC) curves were used to identify appropriate cut-off times. RESULTS: The T-test comparing mean TUGT times between previous fallers and non-fallers demonstrated a significant difference, p=0.005, with means of 12.2 seconds (0.5 S.E.) and 10.6 seconds (0.3 S.E.) respectively. The T-test comparing mean TUGT times between subsequent fallers and non-fallers demonstrated no differences, p = 0.139. The means for this analysis were 11.7 seconds (0.5 S.E.) and 11.0 seconds (0.5 S.E.) respectively. CONCLUSIONS: It was impossible to determine a cut-off time on the TUGT that predicted actual falls in the subsequent year. There were also no differences in TUGT times between subsequent fallers and non-fallers. While there were demonstrable time differences between previous fallers and non-fallers, the sensitivity and specificity at a 10 second cut-off were not high enough to generate confidence in fall classification KEY WORDS: predictive validity , TUGT, reliability, validity



THE EFFICACY OF ACUPUNCTURE VERSUS MANUAL THERAPY IN PATIENTS WITH CHRONIC NONSPECIFIC

LOW BACK PAIN.

Birupakhya Patra, Mr.P.P.Mohanty

Department of Physiotherapy, Swami Vivekananda National Institute of Rehabilitation Training and Research (SVNIRTAR), Cuttack – 754010, Orissa.

INTRODUCTION: Low back pain remains a very common human condition that affects an estimated 80 percent of adult during some period in their life. Among complementary and alternative medicine, Acupuncture has been demonstrated as a powerful therapy, which is associated with clinically relevant improvements for LBP Purpose of the Study: To compare the effectiveness of acupuncture versus manual therapy on pain and disability in patients with chronic non specific low back pain. . METHODOLOGY: Design: Experimental. Sample: 30 subjects were recruited from the outpatient department of SVNIRTAR. Sampling: Random Inclusion criteria: Subjects in 35-55 years of age, complaints of insidious onset of radiating (till posterior knee) or non radiating pain that has lasted for more than 3 months. Exclusion Criteria: Contra – indications to manual therapy. Outcome Measures: Pain (Visual Analog Scale),Oswestry Disability questionnaire Procedure: After the subjects had fulfilled the criteria and signed the informed consent, subjects were randomly assigned to one of the 2 groups and assessed for dependant variables. Post measurement readings were taken after 15 days of therapy. Group I received Maitland (Central PA). Group II received acupuncture stimulated with dense disperse electrical stimulation for 20 minutes continuously. Both groups received therapy intervention for a period of 15 days (one session per day). Data analysis: The dependant variables were analyzed using repeated measures ANOVA. There was one between factor with two levels, and one within factor. All pair wise, post –hoc comparisons was done using a .05 level of significance. RESULTS: The overall result of the study showed significant improvement in pain and oswetry disability questionnaire in both acupuncture and manual therapy group. Acupuncture group showed statistically significant improvement in pain as compared to manual therapy group. However there was no significant difference between two groups in oswetry disability questionnaire CONCLUSION AND CLINICAL SIGNIFICANCE: The results of the study showed that both acupuncture and manual therapy are effective in reducing pain and disability after 15 days of treatment. Acupuncture was significantly more effective in reduction of pain as compared to manual therapy. However both interventions showed similar effects in reducing disability. KEYWORDS: Non-specific low back pain, Acupuncture, Maitland E-MAIL: [email protected]


MISCELLANEOUS SECTION

DIGITAL PAPERS


ABSTRACT NO- 3 (MISC 1)

EFFECTIVENESS OF ARTS BASED THERAPY IN ADJUNCT TO

PHYSIOTHERAPY IN SPECIAL NEEDS CHILDREN

Shah Kartik Parijat Rehabilitation Centre, Mumbai

BACKGROUND: Physiotherapists come across a lot of limitations when it comes to dealing with children. Unlike adults, children have to be handled differently for optimum results and when therapeutic use of art is integrated with modalities of physiotherapy it gives quick, observable and sustained results. And using art forms like painting, play, drama, stories with movements, music, would be beneficial for the therapist as well as the patients to treat them using ideas that they like and help in the over all well being1. AIM AND OBJECTIVE: To find the effectiveness of Arts Based Therapy in adjunct to conventional physiotherapy in special needs children. METHODS: The study design was a cohort study. There were seven participants with clinical diagnosis of mental retardation, cerebral palsy and delayed milestones, who were admitted to NASEOH, Mumbai, between January to July 2010 and were willing to participate in this study. Of this 5 were males and 2 females. Inclusion criteria: Participants with a clinical diagnosis of mental retardation, delayed milestones and cerebral palsy and whose parents were willing to participate in this study. Exclusion criteria: Participants with a history of excessive convulsions, Febrile,

major terminal illnesses.

The therapy included sessions with the children on painting, music, drama, and dance, clay, drumming etc, which would enhance the range of motion and fine motor activities in those children. And most important make the treatment suitable to children needs by making it creative, interesting and expressive. RESULTS: Statistical analysis was done manually and using the SISA (Simple Interactive Statistical Analysis) to verify the results obtained. Correlation tests were also used to find out correlation between the changes in VAS, cognitive and physical domains. There was a significant change in the attitude (readiness for treatment, inner motivation, focus, attention) as well as the physical aspects of the children (3.1 SD+_1.1). This was measured by a questionnaire method as well as VAS scoring. It was found that the range of motion was much improved than the conventional physiotherapy undertakes due to the dance and physical activities undertaken (3.7+_0.5). Also the monotonous job of peg board was done away with due to painting and crafting. Aggression in the children was also taken care of as a friendlier approach was taken with the therapist’s participation in most activities rather than just passive guidance (questionnaire results). CONCLUSION: Arts Based Therapy along with the regular Physiotherapy works for the overall physical and mental well being of special needs children. KEY WORDS: arts, physiotherapy, play EMAIL: [email protected]



EFFECT OF YOGA POSTURES ON PRIMARY DYSMENORRHEA

Dr Gauri S. Kulkarni 1, Dr Mrs. Nilima Bedekar 2

1: P.E.S. Modern College of Physiotherapy, Shivajinagar, Pune-5 2: Sancheti Institute College of Physiotherapy, Shivajinagar, Pune-5

PURPOSE OF THE STUDY: Dysmenorrhea is one of the most common gynecological complain. Yoga postures can be used as a self-medicine in privacy and comfort of their own home. It is mentioned in yoga literature that these postures alleviate the symptoms of dysmenorrhea. This project is an effort regarding quantification of the contribution of yoga

regarding primary dysmenorrhea. AIM: To observe the effect of yoga postures on primary dysmenorrhea. Objectives: To observe the effect of yoga postures on – 1) Pain during menstruation, 2) Number of pads used, 3) Absenteeism at school/workplace, 4) Psychosomatic changes during menstruation. METHOD: a) Study Design: Experimental, within group pre-post b) Sample population: Patient having primary dysmenorrhea c) Sample size: 30 subjects between 15-25 yrs age group d) Sampling technique: Convenient sampling e) Inclusion Criteria: 1) Age group 15-25 years 2) Two years completed after menarche 3) Unmarried females 4) Primary dysmenorrhea f) Exclusion Criteria: 1) Any medical and surgical condition which avoids yogic posture 2) Those subjects who were not able to pay attention towards the programme regularly. g) Outcome measures: Visual Analogue Scale (VAS), frequency of medication, number of pads used, absenteeism at workplace, Moo’s Menstrual Distress Questionnaire (MDQ). h) Data collection: Yoga postures were given three times in a week for three months and one time session was supervised every week. Yogasanas given were as follows - Badhakonasana - 1minute or as per the tolerance, Pschimottanasana-30seconds, Vajrasana-5minutes or as per the tolerance, Trikonasana-1minute or as per the tolerance, Ardhamtsyendrasana-1minutes or as per the tolerance, Shavasana-Duration is not fixed the asana is released when the desired rest is achieved. A record was maintained regarding absenteeism at work place, Visual Analogue Scale, Moo’s menstrual distress questionnaire, pads used and number of medications. Subjects were asked to report any increase in discomfort or untoward event. i) Data analytical test: The data was analyzed statistically by applying paired‘t‘test for pain during menstruation, number of pads used, absenteeism at school/workplace, and Wilcoxon signed rank test for psychosomatic changes during menstruation with the help of SPSS software. RESULTS: Frequency of medication (t=9.5) p<0.05, absenteeism at workplace (t= 8.5) p<0.05, visual analogue scale (z=-4.824) p<0.05, pads used (t=3.15) p<0.05, Moo’s menstrual distress questionnaire (z=-4.784) p< 0.05. CONCLUSION: - Yoga posture, which were planned, can be used as a home remedy and are cost effective. It has not shown side effects in the treatment of primary dysmenorrhea. Pain relief was by inhibition of autonomic nervous system. CLINICAL SIGNIFICANCE: These yoga postures can be used as a home based treatment for women suffering from primary dysmenorrhea after giving training under supervision. KEY TERMS: dysmenorrhea, yoga, MDQ, VAS E-MAIL: [email protected]



EFFECTS OF SUBMAXIMAL PROGRESSIVE RESISTED EXERCISES

ON THE FUNCTIONAL OUTCOME IN INSTITUTIONALIZED ELDERLY POPULATION

Dr Sheetal Aurangabadkar, Dr Shraddha Hazare, Dr Mrs. Neelima Bedekar

Sancheti Institute for Orthopaedics and Rehabilitation, College of Physiotherapy Pune

AIM – To study the effects of Sub maximal Progressive Resisted exercises on functional outcome in institutionalized elderly population OBJECTIVES – To check if any improvement in balance on Berg balance scale mobility on Time up and go test reduction in Depression on Geriatric Depression Scale PURPOSE OF THE STUDY – Muscle weakness, of lower limbs is associated with reduced mobility , loss of balance, in elderly. It has been proved that institutionalized elderly are more prone to risk of falls , depression than community dwelling elderly . Though high intensity progressive resisted exercises has proved to increase muscle strength , there is uncertainty whether sub maximal progressive resisted exercises can improve mentioned outcome measures . METHOD: Study Design – Within group pre and post experimental design, single blinded study. Sample Population–As per inclusion criteria. Sample Size – 38 Sampling technique –done by evaluation format as per inclusion criteria. Inclusion Criteria–Institutionalized elderly , 65 years and above with or without assistive devices. Exclusion Criteria–Acute myocardial infarction, acute Stroke, Cognitive impairments, Osteoarthritis of knee Outcome Measures–Berg balance Scale, Timed Up and Go test, Geriatric Depression Scale Data collection – 1 year PROCEDURE – 38 subjects , mean age ( 71.97+_ 4.87) years, were given resisted exercises in groups – (30- 70 percent of I RM ) to ankle dorsiflexors , plant flexors, hamstrings , quadriceps , hip extensors , hip abductors with free weights.. Pre intervention and post intervention scores of outcome measures were taken by another physiotherapist. Only 1 R M of exercising muscle was disclosed to researcher to make free weights accordingly. There were four dropouts . Data Analysis – Data was analyzed using Microsoft Excel Office, 2003 and SPSS version 10 Timed Up and Go test was analyzed using paired t test . Berg balance scale and Geriatric Depression scale were analyzed using Wilcoxon signed rank test RESULTS – Stastical analysis of 34 subjects - 11males and 23 females, was done . All the parameters Berg balance scale, (z= - 5.659, p = 0.00,) Timed Up and Go test (t= 17.166, 2 tailed sig = 0.00) and Geriatric Depression Scale, (z= - 5.659, p = 0.00) showed significant improvement post intervention CONCLUSION – Sub maximal progressive Resisted exercise – (30to 70 percent of 1 R M) 3 days per week to lower extremity muscles for period of 10 weeks can improve balance , mobility and depression among institutionalized elderly . CLINICAL SIGNIFICANCE - Progressive resisted exercises are safe and cost effective exercise to prevent falls and depression in elderly KEY WORDS - 1 R M, High intensity progressive resisted exercises EMAIL– [email protected]



STUDY OF EFFECT OF VIBRATION THERAPY AND TREADMILL WALKING ON BONE MINERAL DENSITY IN POST-MENOPAUSAL

WOMEN

Reshma Jain, Dr. (Mrs.) Bharati D.Asgaonkar College of Physiotherapy, Topiwala National Medical College, B.Y.L.Nair Hospital, Mumbai Central,

Mumbai 400008 AIMS AND OBJECTIVES: 1. To compare effect of treadmill walking and WholeBodyVibrations on Bone-Mineral Density values and T-scores in post-menopausal osteopenic/osteoporotic women after 12 weeks of intervention. 2. To find which is more effective, treadmill walking or WholeBodyVibrations in increasing the Bone-Mineral Density in 12 weeks intervention. PURPOSE OF STUDY: Treadmill walking and WholeBodyVibrations are both weight-bearing exercises and hence can improve bone strength. Both exercises have variables parameters that can be controlled and monitored during the therapy unlike simpler therapies like brisk walking. However a comparison needs to be done to find out which one of the two therapies is more effective. METHODOLOGY: Study design: Interventional, Prospective, Cross-sectional. Inclusion criteria: Osteopenia/Osteoporosis BoneMineralDensity:- T-score < 1.0, Subjects able to stand on vibrating platform or walk on treadmill, Willingness of subjects Exclusion criteria: Using any other medication that influence bone metabolism, History of Deep vein thrombosis, Subjects with CVS complications. Sample population and size: 58 post-menopausal women with osteopenia/osteoporosis. Sampling technique: Random assignment to one of the following three groups. (All women taking 500mg calcium with 250 I.U vitamin D3) Group A: Treadmill walking, Group B: WholeBodyVibration, C: Control. 15 women in each group completed the protocol,. Outcome measures: Bone-Mineral Density assessments by Qualitative Ultrasound (g/sq.cm), site: right calcaneum, in all 3 groups at baseline and 12 weeks. Data Analysis: By SPSS version- 13. Oneway ANOVA and Post-Hoc Tests- to compare baseline variables and to compare the difference of baseline to post-intervention. Paired t-test: to compare effects within each group. RESULTS: Bone-mineral density in all groups showed significant difference between pre and post intervention. p value: 2.68E-05 in group A, 4.63E-07 in group B, 0.07 in group C. Thus there was improvement in each group. The difference of baseline to post intervention between all 3 groups was significant when results were compared between Groups A & C (p value 0.00039) and Groups B & C (p value 0.00010) suggesting that improvement was better with exercises added to calcium supplements rather than only calcium supplements indicating complementary effect of exercise to calcium supplements. CONCLUSION AND CLINICAL SIGNIFICANCE: Treadmill walking, WholeBodyVibrations and calcium supplements, all improve Bone-Mineral Density. Treadmill walking OR WholeBodyVibrations along with calcium supplements were more superior to only calcium supplements. Treadmill walking and WholeBodyVibrations were equally effective suggesting any of these weight-bearing exercises improve Bone-Mineral Density. KEYWORDS: Bone-Mineral Density, Post-menopausal women, Treadmill Walking, WholeBodyVibrations. E MAIL: [email protected]



EFFECT OF YOGIC PRACTICES ON PARAMETERS OF HEALTH PROMOTION

Anuprita Thakur, Sujata Yardi

Department of Physiotherapy, Pad. Dr D.Y. Patil University, Navi Mumbai AIMS AND OBJECTIVES & PURPOSE OF THE STUDY Modern man faces stress and strain everywhere due to current lifestyle. The body, mind and emotions all are strained by the physiological and psychological responses of the stress he faces in everyday life. Yoga is an ancient Indian science which claims to bestow upon the practitioner various physical, mental and spiritual benefits by practices of various asanas, pranayamas, kriyas, bandhas and meditation techniques. This combination of various yoga practices can be prescribed to achieve a balance in the physiological and psychological domains. However, despite yoga's long history and the enormous number of faithful participants, very little scientific research has been conducted regarding its benefits. The present study thus aims to evaluate the effect of yogic practices on various health promoting body parameters. METHODOLOGY Study design - Experimental Sample population and size- 30 normal, healthy college students in the age group of 18 to 24 years were selected Sampling technique- Random Inclusion/exclusion criteria – Any subjects with past history of musculoskeletal, cardiopulmonary or neurological problems were excluded. Methodology- Various yogic practices like postures (asanas), pranayamas and meditation were practiced for a period of one month. Outcome measures - Health promoting body parameters like blood pressure, heart rate, respiratory rate, chest expansion, flexibility, balance, aerobic capacity and PFT were assessed prior to and on completion of training program. RESULTS WITH DATA ANALYSIS The data was statistically analyzed using the Paired T-test. Following parameters showed significant increase in values post 1 month yoga training: Flexibility, Balance, Aerobic capacity, Chest expansion, Peak Expiratory Flow Rate (PEFR) CONCLUSION AND CLINICAL SIGNIFICANCE The results of this study suggest that practice of yogic postures, pranayamas and meditation have positive effects on health promoting body parameters. Thus yoga can be used to improve the general physical and mental well being in individuals KEY WORDS: Yoga, Health promoting parameters, Asanas, Pranayama, E-MAIL: [email protected], [email protected]


SPORTS SECTION

PLATFORM PAPERS


ABSTRACT NO 15 (SPORTS 1)

IMMEDIATE EFFECTS OF DYNAMIC WRIST EXTENSOR BRACE ON PAIN-FREE AND MAXIMUM GRIP STRENGTHS IN

SUBJECTS WITH LATERAL EPICONDYLALGIA

Vincent Singh 1, Prema Vincent Singh 2, Paresh Kumar Panda 3

1: Tata Memorial Hospital 2: Consultant Physiotherapist Lion's club of Andheri

AIM AND OBJECTIVES: To evaluate effectiveness of Dynamic Wrist Extensor Brace for lateral epicondylalgia. PURPOSE OF STUDY: To evaluate the immediate effect of the dynamic wrist extensors brace in improving pain free and maximum grip strength in lateral epicondylalgia. METHODOLOGY Study design: It is a comparative study and a crossover design. Sample population and size: 32 male recreational tennis players, 38-63 years old. Sampling technique: Simple randomization. Inclusion Criteria: Local pain and tenderness over lateral epicondyle of humerus, Recreational tennis player, Recurrence, Persistent symptoms, Age between 35-65 years, Positive Mill’s and Cozen's Test Exclusion Criteria: Cervical Spine dysfunction, Radial tunnel syndrome, Posterior interosseous nerve syndrome, Poly arthritis, Radio-humeral bursitis, Bilateral Lateral epicondylalgia, Duration of symptoms less than 6 weeks, Fracture of arm, deformity, surgery and neuro-muscular injury, Neurological or rheumatic abnormalities, Acute infection and systemic diseases, Malignancy Outcome Measures: Pain Free, Maximum Grip Strength and Visual Analogue Scale. Data collection and analysis After signing informed consent subjects were randomized into two groups and given two different orthotic devices – tennis elbow-band(splint) and dynamic extensor brace developed by the authors. Pain free grip strength and maximum grip strength measured using smedly type hand held dynamometer in standardized testing position. During maximum grip strength pain was recorded using visual analogue scale. Same procedure was followed after 24 hours interchanging the treatment. The pain free and maximum grip strength were compared with 't' test. Pain during maximum grip strength compared with the mann-whitney test. RESULTS: There was no statistically significant difference found in the pain free grip strength (p=0.84) and maximum grip strength (p=0.95) between two groups. Brace group showed significant reduction in the VAS score (p=0.001). The reduction in the VAS score seen to be almost 2 or more in 65% of the cases . There was no correlation found between pain free and maximum grip strength CONCLUSION & CLINICAL SIGNIFICANCE: Dynamic extensor brace may help in reducing pain during strong grips that is necessary during tennis like sports. Reduction in pain may be due to the counter balancing mechanism of the brace. So this brace may help in reducing chances of repeated injury during continuous use of the affected arm. KEY WORDS: Lateral epicondylalgia, Grip strength, Dynamic extensor brace. E-MAIL: [email protected]



EFFECT OF ANXIETY COPING STRATEGIES IN REHABILITATION OF AN INJURED ATHLETE

Gaurav Chawla

Department of physical medicine and Physiotherapy, Indraprastha Apollo Hospitals, New

Delhi

AIM AND OBJECTIVES OF STUDY: To study the psychological component of rehabilitation along with physical rehabilitation of the injured athlete and during the periods of immobility aiding in decreasing the negative outcomes of restricted mobility, enhance the task efficacy and to assist with motivation and compliance. PURPOSE OF THE STUDY: Much of the existing literature has focused only on the physical rehabilitation so the present study focuses on the psychological appraisals along with physical rehabilitation of an injured athlete. DESIGN AND METHODOLOGY: Design: Pre –Post test experimental study. Sample population: 70 University level sports person with acute injuries of upper, lower limb and low back pain with anxiety above 40 or more Sampling method: Randomly assigned into two groups of 35 each. i) Group I: Experimental (EMG Biofeedback + Physical therapy) ii) Group II: Control (Physical therapy) were given 8 sessions. Main Outcome Measures: Anxiety scores were recorded using standardized self –report measure State Trait Anxiety Inventory (Spielberger et al., 1970) and Medicaid system EMG Biofeedback Biotrainer MBF-4000, Visual Analogue scale, Disability Of Arm, Shoulder and Hand (DASH) symptom scale for upper limb and Lower Extremity Functional scale (LEFS) for lower limb and OSWESTRY low back pain disability Questionnaire, Heart rate and Blood pressure. Statistical tests: Data was analyzed using paired and unpaired t tests. Mean, standard deviation values were used to prepare summary statistic. The ‘p’ value was taken as 1% and 5% level of significance. RESULTS AND CONCLUSION: The Intra-group comparisons reveal statistically significant decrease in the EMG activity in Experimental group (t=9.90, p<0.001) than in control group (t=0.55, p>0.05). Both the groups had reduced Anxiety levels, Pain levels, Heart rate and Blood Pressure and improved Functional Status as compared to Day 1and the Experimental group(EMG Biofeedback + Physical therapy) was found to be more effective in reducing STAI Scores, EMG activity, Functional Status, Pain Scores, Heart rate, Blood Pressure than the Control group (Physical therapy). CLINICAL SIGNIFICANCE: Physical therapy with psychological training helps the athlete not only to cope with the feeling of anxiety, pain and stress but also will further bring an insight in the work of a Sport Physiotherapist which will enhance the functional outcome of an injured athlete. KEY WORDS: EMG biofeedback, anxiety, - State trait anxiety inventory, VAS- Visual analogue scale, DASH-Disabilities of the arm shoulder and hand scale, LEFS-Lower extremity functional scale. EMAIL: [email protected]



PREVALENCE OF MUSCLE STRAINS DURING FIRST AND

SECOND HALF OF FOOTBALL MATCHES – A RETROSPECTIVE CROSS SECTIONAL SURVEY

Brijeshwar Chahal, Dr. Stephen May

Sheffield Hallam University, Sheffield, U.K

AIM: To ascertain the seasonal prevalence of muscle strains among Indian professional and semi-professional football players during 2008-2009 season, at Mumbai, India. OBJECTIVES: To determine the seasonal-prevalence of muscle strains during 2 halves of football matches, to investigate the association between muscle strains and possible risk factors (inadequate warm up, fatigue, lack of hydration and inappropriate recovery pattern) and to explore the perceptions of physical trainers regarding the cause of muscle strains. METHODOLOGY :

a) Study Design : Retrospective Cross Sectional Survey b) Sample population: n=40 (physical trainers of football clubs) c) Sampling technique : Purposive sampling d) Inclusion and Exclusion criteria : Physical trainers having a minimum of 2

years professional or semi-professional team experience, qualified to collect data regarding fitness testing, possessing the required information about the players from the previous season, and willing to share that data were selected and participants not meeting the criteria were excluded.

e) Outcome measure : Self administered questionnaire f) Data collection and Analysis : Completed Questionnaires were collected from

participants via e-mail and data was analysed by SPSS (version 17.0). Seasonal prevalence was reported in terms of frequency, and the relationship with possible risk factors was established using Spearman ranked test and chi-square tests. Open ended questions were analysed by thematic analysis.

RESULTS: Second half showed a higher prevalence rate of muscle strains than first half. 20% (n=4) clubs reported muscle strains (N = 6-15) during the second half compared to none during the first half (Mean : 2.15; Standard Deviation : 0.671). A strong and positive association (x2=8.235) was found between first half strains and warm-up exercises with inappropriate intensity, duration and frequency (p=0.004) and first half strains with previous injury also showed a highly significant (p=0.024) and positive association (x2

=5.089). Although fatigue among players showed a stronger correlation with second half strains (r=0.318), this was not significant (p=0.268). Majority of the trainers considered lack of hydration and inadequate warm-up to be the main risk factors for muscle strain. CLINICAL SIGNIFICANCE: Results imply a wide variation in training and warm-up protocols among Indian football clubs as well as uncertainty among physical trainers regarding injury recovery increasing the risk of muscle strains. Physiotherapy has a role to play in the management of these sporting injuries. KEYWORDS: Muscle strain; Self administered questionnaire; Risk factors; Prevalence




EFFECTS OF STATIC AND DYNAMIC STRETCHING ON AGILITY PERFORMANCE IN TENNIS PLAYERS

Dr. Hardik R Trambadia, Dr. Mehul Jadav Parul Institute of Physiotherapy,Limda, Vadodara.

BACKGROUND & PURPOSE: Most sports individuals or athletes including tennis players perform stretching during warm-up prior to physical activity in order to prevent injuries and enhance sports performance by improving flexibility. Traditionally static stretching exercises have been a prominent feature of warm up routines. On the other hand, dynamic stretching improves knee joint position sense, increases oxygen uptake and lowers lactate concentration. Hamstring and calf muscle group play a significant role in agility function in tennis players. So the study is conducted to check the effect of static and dynamic stretching of hamstring and calf muscle on agility performance in tennis players. AIMS AND OBJECTIVES:

1) to check effect of static stretching on agility performance in tennis players 2) to check effects of dynamic stretching on agility performance in tennis players 3) to compare effects static and dynamic stretching on agility performance in

tennis players. METHOD: 36 tennis players were taken for the study and the three different stretch protocols (no stretch, static stretch and dynamic stretch) were performed on each of them and time taken for the two agility drills were recorded in a pre and post stretch interventions. Study design :– Experimental design Sampling technique :- Purposive sampling technique Outcome measures:-

1) Shuttle run test 2) Tennis specific agility test

Inclusion criteria:- 1) Subjects who have participated in regular training programme and had been

playing tennis for at least 1 year Exclusion criteria:-

1) Acute impairment of spine or lower extremity. 2) Vestibular dysfunction or balance disorder 3) H/O surgery in either lower extremity 4) H/O neurological disorder affecting upper and lower extremities 5) BMI above 25 and below 20

Data Analysis:- paired t test was applied to check the effects of different stretching techniques on both the agility drills RESULT:-Results show that there was a significant decrease in time taken to complete the agility drill for the players performing dynamic stretching than those compared to no stretch and static stretching of the hamstrings and calf muscles. CONCLUSION: Static stretching neither improves nor reduces performance and that dynamic stretching enhances performance of tennis players. KEY WORDS: agility, tennis, static stretching, dynamic stretching.



SPORTS SECTION

DIGITAL PAPERS



COMPARISON BETWEEN DEPTH JUMP AND COUNTER MOVEMENT

JUMP IN MALE BADMINTON PLAYERS

Dr. Kashmira Sabnis, Dr. Seema Saini

Padmashree Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune – 18. AIM: To find effectiveness of jump training in male Badminton players. OBJECTIVE: To study effectiveness of jump training in male Badminton players and to compare depth jump training and counter movement jump training for increasing vertical jump height. PURPOSE OF STUDY: Many controversies exist between effects of jump training programs. Hence purpose was to find which jump training is more effective to increase vertical jump height. METHODOLOGY: Study Design - Experimental Sample Population – Male Badminton players Sample Size - 30 Sampling method - Simple Random sampling Inclusion criteria - Male Badminton players, aged 20-25 years, playing Badminton for at least 1 year. Exclusion criteria - Amateur and professional players, history of musculoskeletal disorders within 6 months, cardiovascular disorders, neurological disorders and body weight more than 220 lbs. Outcome Measure - Static Vertical jump test DATA COLLECTION AND ANALYSIS - 30 players were randomly divided into two groups: - countermovement jump group and depth jump group. Their static vertical jump was assessed and they were given a separate training program for 6 weeks (two sessions/week). Depth jump program consisting of 10-minute warm-up and standardized technique to step off the 40cm drop box platform and immediately rebound upward with maximal effort. Countermovement jump program consisted of a standardized 10-minute warm-up and then from standing position rapidly dip down to 900 knee angle, and jump as high as possible. Vertical jump was again assessed after 3rd week and 6th week. Mean vertical jump score in countermovement jump group was: Pre-training - 38.5 cms 3 weeks – 39 cms 6 weeks - 39.7 cms Mean vertical jump score in depth jump group was: Pre training - 39.6 cms 3 weeks - 40.4 cms 6 weeks - 41.4 cms RESULTS: Using paired t test, there was a significant increase in vertical jump height post-training in both groups at 3 and 6 weeks. On applying unpaired t test, increase in depth jump group was significantly more than increase in counter-movement jump group at 6 weeks. CONCLUSION: Jump training program is effective to increase vertical jump height in male Badminton players. However, depth jump training program is significantly more effective for improving vertical jump height as compared to countermovement jump training program. CLINICAL SIGNIFICANCE –Male Badminton players would be able to experience gains in vertical jump ability through depth jump training program. KEY WORDS – vertical jump, depth jump, countermovement jump, Badminton E-MAIL – [email protected]



THE USE OF ARM SPAN AS A PREDICTOR OF HEIGHT- A STUDY ON HEALTHY INDIVIDUALS

Sneha Makwana, Dr. Yagna Shukla,

Govt. Physiotherapy College, Civil Hospital, Ahemdabad, Gujarat AIM OF THE STUDY: To find out whether arm span can be used as an alternative to standing height for measurement of stature. PURPOSE OF STUDY: Measurement of the height of patients is required for determination of basic energy requirements and standardization of measures of physical capacity. However, in some situations the exact height cannot be determined directly like in paraplegic and quadriplegic patients. In such circumstances, an estimate of the height has to be computed based on other body parameters. Arm span is one of the parameter in predicting the body height. So the need of study is to find out whether arm span can be used as an alternative to standing height. METHODOLOGY STUDY DESIGN- Cross sectional study SAMPLE POPULATION AND SAMPLE SIZE- 100 healthy students of Govt. Physiotherapy College, Ahemdabad. SAMPLING TECHNIQUE- Convenient Sampling INCLUSION CRITERIA- Healthy individuals with age group of 21-30 years EXCLUSION CRITERIA- Any previous musculoskeletal injury. DATA COLLECTION AND ANALYSIS- 100 healthy students of Govt. Spine Institute, Ahemdabad were taken and they were well explained about the study. A written informed consent was taken. Standing height was measured with the individual standing barefoot on the platform of the stadiometer with the upper back buttock and heels pressed against the upright position of the instrument. Arm span was measured with a flexible steel tape from the tip of the middle finger on one hand to the tip of the middle finger on the other hand with the individual standing with her back to the wall with both arms abducted to 90°, the elbows and wrists extended and the palms facing directly forward. Data was collected and analysed by applying Z-test to determine the significance of difference between standing height and arm span. RESULT: The value of Z is 6.2 and p(<0.01). Mean and standard deviation of arm span is (163.1,6.83) and standing height is ( 157.4, 5.48) CONCLUSION AND CLINICAL SIGNIFICANCE- The value of Z shows that the difference between arm span and standing height is highly significant. Hence arm span cannot be used directly as an alternative to standing height for measurement of stature. KEYWORDS- Standing height, Arm span, Stature EMAIL- [email protected]



COMPARISON OF ROCK PORT 1-MILE WALK TEST AND 3-MINUTE STEP TEST FOR PREDICTION OF VO2MAX IN

COLLEGE AGED PARTICIPANTS.

Ashok Ravat, Dr.Anjali Bhise

Govt. Physiotherapy College, Ahmedabad, Gujarat

PURPOSE OF STUDY: Purpose of study is to compare the estimated VO2max by using Rockport 1-mile walk test and 3-minute step test. OBJECTIVE: The objectives of the study are: 1] To measure the VO2max after treadmill walking by Rockport 1-mile walk test. 2] To measure the VO2max after 3-minute step test. 3] To compare the estimated VO2max of Rockport 1-mile walk test and 3-minute step test. METHODOLOGY: Study design: Observational Comparative study Sample size: 30 Source of sample: Govt. Physiotherapy college,Ahmedabad Material used: Treadmill, step bench[40 cm], pen, paper Inclusive criteria: Age between 20-25 year, person having no cardiovascular, pulmonary and musculoskeletal disease. Exclusive criteria: Age less than 20 and above 25 year, person having cardiovascular, pulmonary and musculoskeletal disease. Outcome measures: VO2max Sampling technique: Convient sampling Data collection and analysis: 30 normal subject were randomly selected.Each subject had undergone Rockport 1-mile walk test and 3-minute step test at alternate days for preventing cross over effect then VO2max was measured. Paired “t” test was applied for data analysis. RESULTS: The obtained value of “t” falls in 99% confidence interval. Calculated value of t [4.8] is much larger than the table value of t[3.66] at 29 degree of freedom. Therefore the results are highly significant. CONCLUSION: There is significant difference in estimated VO2max after rockport 1-mile walk test and 3-minute step test in college aged participants. KEY WORDS: VO2max, Rockport 1-mile walk test, 3-minute step test EMAIL: [email protected]



LEVEL OF PHYSICAL FITNESS IN 1ST YEAR PHYSIOTHERAPY STUDENTS.

Dr. Devyani Zende, Dr. Neha Gotmare, Dr (Mrs.) Razia Nagarwala


AIM: To find the level of physical fitness in 1st year physiotherapy students. OBJECTIVES: To measure the level of cardio respiratory endurance by observing the aerobic endurance, flexibility and muscular endurance component of physical fitness in the students of 1st year physiotherapy.To measure the anaerobic capacity of 1st year physiotherapy students. METHODOLOGY: Study design: Cross sectional study. Sample Population & size: N = 45 students. [6 – Males, 39 - Females] Sampling technique: Convenient Inclusion Criterion: All healthy normal students either males or females from Sancheti Institute College of Physiotherapy within the age group 17-20 years. Exclusion criterion: Any neurological and/or musculoskeletal disorder. Any associated pulmonary disorder like Asthma, Bronchitis. Any associated Cardiac disorder. Any abdominal or spinal surgery done within previous 6 months. METHOD: A written consent was taken. Subjects were explained the procedure. Subjects were screened for the exclusion criteria on the basis of Par Q and you questionnaire along with relevant history. Subjects were asked to perform Flexibility, Muscular endurance, Cardio respiratory endurance, Anaerobic capacity. Outcome measure: Sit and Reach test, Curl up test, Harvard’s Step test, Sargeant Jump test Statistical Analysis: Mean and Standard Deviation. RESULTS: As observed for Harvard’s test score the mean was 34.74(+ 23.16) for all the subjects. Whereas the mean for males was 73.7 (+23.99) and the mean score for females was 28.73(+ 16.40). Similarly the mean score for Sargeant Jump test for all the 45 subjects was 29.06 (+ 6.75). With 40.16 (+ 3.17) as mean score for males and 27.58 (+ 5.54) as mean score for females. The average score for Curl-up test was 34.76 (+ 11.19), for males it was 47.66 (+18.18), females it was 33.67 (+ 9.15) and for Sit and Reach test the mean was 0.00 (+ 0). CONCLUSION: Results show that the aerobic fitness observed through Harvard’s step testing is poor among the 1st year physiotherapy students of the sample surveyed. But the abdominal muscle endurance is excellent, However they show average flexibility and below average Anaerobic fitness through Sit and Reach test and Sargeants jump test respectively. CLINICAL SIGNIFICANCE: There is a need of evaluation and fitness training in physioyherapy students through out the course to cope up with the increasing physical demands. E MAIL: [email protected] ; [email protected]


PAEDIATRICS SECTION

PLATFORM PAPERS


ABSTRACT NO 62 (PAEDS 6)

FAMILY AWARENESS OF LEGISLATIVE ISSUES ON CEREBRAL PALSY-CROSS SECTIONAL SURVEY

Vandana J. Rathod

Lecturer, K J Pandya College of Physiotherapy, Sumandeep Vidhyapeeth, Vadodara,

Gujarat. INTRODUCTION:

Disability particularly caused by cerebral palsy, though important, is often neglected aspect in the community. The prevalence of disability is 7 per 1000 live births in India. 40% of the parents are not aware about the legal issues for person with disability in developing countries. It has never received adequate attention from parents, relatives and people living in surroundings. Ignorance, lack of awareness and lack of knowledge make the disability invisible. Most of the authorities appointed the legislation are not fully functional. OBJECTIVE: To find out family awareness of legal rights of person with cerebral palsy to ensure dignity and legal rights. METHODOLOGY: Study design: Cross sectional survey Study setting: Department of Peadiatric physical therapy, Dhiraj general hospital, Sumandeep vidhyapeeth, Vadodara. Selection criteria: Legal adult family members of children diagnosed with cerebral palsy, volunteering to participate in survey after signing informed consent form. Sample size: 112 legal adult family members of cerebral palsy subject. PROCEDURE: 112 legal family members of cerebral palsy child were surveyed through schedule method with a questionnaire about four acts (Person with disability act, mental health act, united nation convention of person with disability and national trust act) of Indian constitution. The questionnaire consisting of 20 questions about these acts were content validated for these purpose. The data were analysed by using percentage values to make interpretation. RESULTS:

Out of 112 surveyed 72.32 % were not knowing about the Indian constitution for disabled people. Remaining 27.67 % knew about the acts and only 11.60 % were getting benefitted from such acts. CONCLUSION

The awareness about legislation of family members having children with cerebral palsy is less and needs immediate attention to improve quality of life of persons with disabilities. KEY WORDS: Cerebral palsy, person with disability, legal rights. E-MAIL: [email protected]



POSTURAL SWAY BETWEEN SINGLE AND DUAL TASK CONDITIONS IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY

D A Asir John Samuel, John Solomon, Divya Mohan.

Dept. of Physiotherapy, MCOAHS, Manipal University, Manipal.

AIM OF THE STUDY: To compare the postural sway between single task and dual task condition in spastic diplegic cerebral palsy children (SDCPC) METHODOLOGY: Sample population: SDCPC attending CP clinic, Kasturba Hospital, Manipal. Study design: Cross sectional study Sampling technique:Convenience sampling Sample size:N = 20 Inclusion criteria: Age 8 -17 years, Functional mobility with GMFCS I, II and III, Ability to maintain static stance for 30 seconds without assistance, At least 6 month post orthopedic surgery. Exclusion criteria: Uncooperative children, Children with hearing deficit, Inability to articulate numbers, At least 6 month post orthopedic surgery, Administration of Botox injection within last 6 months. Material used: Good Balance posturography (GBP) Metitur Ltd., Jyvaskyla, Finland PROCEDURE:

1. 20 SDCPC who met the above mentioned inclusion criteria were recruited for the study. 2. Cognitive task of subtracting 1/2/3/4/6/7/8/9 from 100 is set as their dual task 3. Attention load level equating was set at 70% accuracy 4. Initially the child was made to stand in the GBP for 30 seconds with hands crossed and their

sway velocity inanteroposterior(AP) andmediolateral (ML) directions and Velocity Moment (VM) were recorded for single task.

5. For the dual task condition the child is asked to tell the consecutive subtracted values for 30 seconds while standing in the GBP and their readings are recorded as above.

6. The difference in sway between single and dual task conditions were statistically analysed. Outcome measure:

1. Difference in VM of postural sway betweensingle and dual task situation 2. Sway velocity in the APand ML directions.

Data analysis: The difference in postural sway between single and dual task condition was analysed using Wilcoxon signed Rank test RESULTS:

• Velocity moment of single task-63.4(96.38, 35.88)mm²/s and dual task-156.1(233.45, 85.66)mm²/s

• Sway velocity in AP direction of single task-13.55 (21.88, 10.53)mm/s and dual task-24.35 (38.45, 16.05)mm/s

• Sway velocity in ML direction of single task-10.1(13.05, 8.28) mm/s and dual task-17.25 (22.55, 13.03)mm/s

• Wilcoxon signed Rank test shows statistically significant of P <0.05 between the single and dual task condition. CONCLUSION: Postural sway increases in dual task condition in SDCPC. CLINICAL SIGNIFICANCE: Identifying the impact of dual-task condition on postural control will help us to understand the extent of the balance problem faced by the SDCPC. KEYWORDS: Dual task, postural sway, posturography, cerebral palsy. EMAIL: [email protected]



DEPRESSION AND QUALITY OF LIFE IN MOTHERS OF CHILDREN WITH CEREBRAL PALSY

Hetal Chovatiya, Dr Shraddha Diwan

S.B.B. College of Physiotherapy, V.S.General Hospital, Ahmedabad, Gujarat.

AIMS AND OBJECTIVE: To evaluate the depression and quality of life in mothers of children with cerebral palsy. PURPOSE: Children with cerebral palsy suffer from several problems like impaired gross motor development, balance, locomotion, sensory integration dysfunction. So family especially the mothers undertake a lot of stresses & social and emotional difficulties. The purpose of study is to evaluate depression and quality of life in mothers of children with cerebral palsy. METHODOLOGY: a) Study design: Descriptive analytic study b) Sample population: 30 mothers of children with cerebral palsy c) Sampling method: Random sampling d) Inclusion criteria: All the mothers of children having cerebral palsy with their informed consent coming to paediatric physiotherapy department of S.B.B. College, V.S. General Hospital, Ahmedabad. f) Exclusion criteria: Children having other neurological condition like erb’s palsy, Down syndrome, Autism. e) Outcome measure: SF-36 for quality of life, Beck Depression inventory- II for depression g) Method of data collection: Schedule method h) Statistical analysis: Done by computing Mean and Standard deviation RESULTS: Mean value for Beck Depression inventory II is 16.76± 5.71 which is suggestive of moderate symptoms of depression in mothers of children with cerebral palsy. Mean value for SF-36 subscales is; functional limiting (78.79± 13.49), role limitation due to physical health(35±15.53), role limitation due to emotional problem(31.11±12.17), energy(53±8.93), emotional well being(61.2±9.91), social functioning(48.83±12.40), pain(55.67±11.79), general health(69.67±12.10) which are lower in comparison with normal values. CONCLUSION & CLINICAL SIGNIFICANCE: This study suggestive of prevalence of depression in mothers of children with cerebral palsy and quality of life especially role limitation due to physical health & emotional problems and social functioning are more affected than other components. So different coping strategies and psychosocial programme must be designed and implemented to improve social & emotional well being KEY WORDS: Cerebral palsy, Depression, Quality of life. EMAIL: [email protected]



EFFECT OF EARLY INTERVENTION ON THE BEHAVIOR OF PREMATURE NEONATES

Kirti Joshi 1, Anjali Puntambekar 2

1: Ayushman College, Bhopal

2: LTMM College, Sion, Mumbai PURPOSE OF THE STUDY: - A neonate’s behavior is a reflection of his adjustment to the new environment and his neurophysiological development. Premature neonates face a very unusual and often noxious environment in the intensive care unit. There is a need to understand the sensory and motor needs of these babies and to help sensory experiences whenever possible. This study aims to assess the effect of early intervention in the form of environment modification and maternal participation on the behavior of premature neonates. Design: -This comparative study was conducted in the premature unit of a tertiary care hospital. Sample Population: - 32 premature neonates. Sampling Method: - Randomly selected sample population. Inclusion Criteria: - The neonates included in the study had to have a clinically stable state, gestational age between 32-36 weeks and birth weight between 1500-2500 gms. Exclusion Criteria: - Neonates having any congenital malformation, with poor prognosis of survival and on any artificial ventilation support were excluded from the study. Method of data collection: - After taking their mother’s consent, the first sixteen neonates were assigned to control (A) group and the next sixteen to the study group (B) neonatal. The neonatal behavior assessment scale (NBAS) was administered to both the groups on the third day of life. Both groups underwent standard nursery care. Group B additionally received early intervention in the form of positioning and sensory motor stimulation by mothers under supervision. Both the groups were reassessed with NBAS on the eight day of life. Statistical test: - Standard descriptive statistics were determined for directly measured and derived variables. Unpaired‘t’ test was used to analyze Coefficients of NBAS using SPSS version 14.0. A 5% level of probability was used to indicate statistical significance.

RESULTS: - Group B showed significant improvement in the clusters of orientation (t=2.9), Autonomic stability (t=3.35) and individual items of Cost of attention (t=2.78), Robustness and endurance (t=2.25), Regulatory capacity (t=2.98) and Reinforcement value of infant behavior (t=3.0). CONCLUSION: - The study shows that early intervention in the form of environment modification and maternal participation enhances the self – organization and interaction and brings about a positive change in premature neonates behavior. Thus, the presence and involvement of the mother along with environment modifications can be used as an effective tool to enhance neurophysiological development in premature babies. KEYWORDS: - Premature neonates, maternal participation, environment modification, neonatal behavior assessment scale, neurophysiological development. EMAIL: [email protected]



EFFECTIVENESS OF SENSORY INTEGRATION THERAPY AND PLAY THERAPY IN CHILDREN WITH AUTISM

- SINGLE BLINDED COMPARATIVE STUDY

Dr. Jagatheesan A.

K J Pandya College of Physiotherapy, Sumandeep University, Vadodara, Gujarat. INTRODUCTION

Autism is a neuro developmental disorder characterized by qualitative impairments in social interaction and communication skill, along with a restricted repetitive and stereotyped pattern of behavior. Etiology of autism is unknown and some resources believe it may be genetic. Prevalence of autism is 4-6 per 1000, Males affected 4 times more than Females and is estimated that there are 40-lakh individuals in India. The consequences of autism includes and not restricted to problems in social development, communication defects, repetitive behavior, less eye contact & attention to social stimuli, unusual gestures, diminished responsiveness & vocal patterns and self-injury. Treatment for autism is not definite. Medications are used to improve general well being of the subjects. The other treatments may be used are Psychotherapy, Behaviour Therapy, Developmental Models, Structured Teaching, Intensive & Sustained Special Education, Family Education, Music therapy, Hypnosis, Occupational therapy, Sensory Integration and Play therapy. OBJECTIVE: To compare the effect of Sensory Integration Therapy and Play therapy in children with autism. METHODOLOGY Study design: Single Blinded Comparative Study Sampling design: Convenience Sampling Sample size: 30 children with autism randomly (lottery method) assigned into 2 groups, 15 each. Study Setting: Multi center study done at outpatient department of two physiotherapy colleges and two special schools. Ethical Clearance: Study was approved by local institutional review board. Inclusion criteria: Children of both sexes with age between 3 and 7 years diagnosed with Autism by Clinical Psychologist using DSM-IV criteria. Exclusion criteria: Epilepsy, Visually impaired, Auditory impaired, Cerebral palsy, Children under sedatives. Duration of intervention: Sensory integration therapy (Group-A) or Play therapy (Group-B) with specific protocol was given for 1 hour/day for 6 days in a week for 6 months. Intervention was given by post graduate pediatric physiotherapists having minimum one year clinical experience. Outcome measure & Tester: Indian Scale for Assessment of Autism by National Institute for Mentally Handicapped(NIMH), Secunderabad, Andrapradesh. All the subjects were assessed before and after intervention of 6 months by blinded post graduate pediatric physiotherapist. DATA ANALYSIS & RESULTS: Data were analyzed by Wilcoxon Signed Rank Test and Mann Whitney U-Test using SPSS-17. There is statistically significant improvement in both groups and play therapy shows more improvement than sensory integration therapy with p value <0.05. CONCLUSION: Play therapy is effective in the treatment of children with autism than sensory integration therapy. KEY WORDS: Autism, Sensory Integration Therapy, Play therapy. EMAIL: [email protected]



TO STUDY THE EFFECT OF INCORPORATION OF REGULAR RHYTHM IN EXERCISES ON MOTOR PERFORMANCE OF

CHILDREN WITH CEREBRAL PALSY.

Amruta Nerurkar, Sujata Yardi

Pad. Dr. D. Y. Patil University. AIM: To study the effect of incorporation of regular rhythm in exercises on motor performance of children with cerebral palsy. OBJECTIVES: To study the effect of regular rhythm when used in exercises on:

1) Gross motor function assessed using Gross Motor Function measure 66. 2) Temporospatial parameters of gait. 3) Fine Motor function assessed using Jebson Taylor hand function scale

Regularity of rhythm is an attribute of physiological functions like respiration, cardiac cycles, menstruation. Studies have shown the human tendency to do things rhythmically with psychological security, memories of intrauterine experience as well as energy conservation being stated as the possible causes for this preference. Exercises making use of rhythm as a feature have been used in speech therapies as well as in physical training. No such study is found to have been done in children with Cerebral Palsy. The rhythm perception and sequencing skills are not explored enough in patients with cerebral palsy as the emphasis is laid on the acquisition of basic voluntary skills. Hence the purpose of this study is to examine the effect of regular rhythm when used as a feature of conventional exercise . In an experimental study design a sample size of 30 patients diagnosed with Cerebral Palsy was selected. Inclusion Criteria:

1) Age group of 6 to 12 years 2) Topographically classified as Diplegics & Hemiplegics 3) Intelligence Quotient> 80.

Exclusion Criteria: 1) primary visual & Auditory dysfunction.

30 patients were divided into 2 groups of 15 each based on age , & classification of Cerebral palsy. One group was given conventional exercises with one hand painting activity for 6 weeks 3tmes/ week. 2nd group is given the same exercises making use of metronome to induce temporal rhythm . The hand painting task for this group is designed using spatial rhythm . RESULTS: Pre & post measures taken in the form of GMFM , Temporospatial parameters of gait( p value < 0.0005) & Jebson Taylor hand function measure which showed a statistically significant change in both groups of patients. All parameters showed a greater change in the 2nd group. CONCLUSION: Inclusion of regular rhythm in conventional exercises has significant effect on motor function. CLINICAL IMPLICATION: This can be used in clinical setting to enhance function. KEY WORDS: Regular Rhythm, Cerebral Palsy. EMAIL: [email protected]



IDENTIFICATION OF DELAYED MOTOR DEVELOPMENT UNDER THE AGE OF 4 MONTHS IN NEONATES USING TEST

OF INFANT MOTOR PERFORMANCE (TIMP): LONGITUDINAL STUDY

Maya Shahane, Asha Chitins, Reena Modi, Sujata Noronha, Dr Prem Seth, M.D.(Paed), D.C.H., Gajanan Bhalerao

AIM: To identify the delayed motor development in Neonates under the age of 4-5 months. PURPOSE OF STUDY: TIMP provides a comprehensive assessment of postural and selective motor control needed for functional use in early infancy. This test can be used from 34 week post conceptional age through 4 months post term in pre mature infants or up through 17 weeks chronological age for term-born infants. We used TIMP to screen neonates under the age of 4 months for delayed motor development or atypical motor performance or to discriminate between neonates with typical development and those who are delayed or who have movement dysfunction and were thought to be capable of providing predictability to later motor outcome. METHODOLOGY: Study design – Prospective observational study (preliminary pilot study) Sample size - 24 subjects (8 full term & 16 preterm) Sample population- Neonates Sampling method: - Convenient Sampling Outcome Measures: - Test of Infant Motor Performance (TIMP) PROCEDURE: We studied 13 neonates who had normal scores on vjoatas, immediately post birth and were labeled normal neonates and were discharged. These neonates were called every 2 weeks till 4 months of age for neuro-developmental follow-up to the pediatric OPD, Bombay hospital, Mumbai. They were assessment using TIMP. RESULTS: On comparison of the sample on the TIMP percentile graph, 18/24 neonates showed far below average level performance. In full term neonates 4/8 showed below average level performance. In pre term neonates 14/16 showed below average level performance showed delayed development which TIMP picked up, although they showed normal scores on vjoatas post birth. CONCLUSION:

1. TIMP is a good tool to identify and screen delayed motor development under the age of 4 months in neonates.

2. TIMP is sensitive to motor performance of infants at term-equivalent age. 3. TIMP serves as a tool for providing anticipatory guidance regarding the next

development parents or health professionals should expect in their infants. KEY WORDS: Neonates, Test of Infant Motor Performance (TIMP), Delayed motor development EMAIL: [email protected]



MOVEMENT ASSESSMENT OF INFANTS (MAI) AS A PREDICTOR OF ONE YEAR NEUROMOTOR OUTCOME IN VERY

LOW BIRTH WEIGHT INFANTS.

Deepa Metgud 1, Dr V. D. Patil 2, Dr S. M. Dhaded 3

1: KLEU Institute of Physiotherapy Belgaum

2: J.N.Medical College Belgaum 3: J.N.Medical College Belgaum

AIMS AND OBJECTIVES/PURPOSE OF THE STUDY- The aim of this study was to find the specific age (4, 6 and 8 months of corrected age) at which Movement Assessment of Infants scale (MAI) can best predict neuromotor outcome at one year of corrected age in Very Low Birth Weight infants (VLBW) in developing country like India as there are no studies done to find the usefulness of MAI in identifying neuromotor problems in Indian population. Also there are no reported studies on predictive validity of 6 month MAI in VLBW infants. METHODOLOGY- Study design- Hospital based Prospective longitudinal study Sample population- Very low birth weight infants (≤1500gms) Sampling method/Technique used- Convenience sampling (non probability sampling) Outcome measure- Bayleys scale of infant development (BSID-II) Method of data collection-observational method (structured observation) Statistical tests used for data analysis-Data was analyzed using statistical measures of validity like sensitivity, specificity, positive predictive value and negative predictive value. METHOD In this hospital based prospective longitudinal study 60 infants were recruited consecutively based on the inclusion criteria of birth weight≤1500gms and admitted to Neonatal Intensive Care Unit (NICU) for initial management .Infants with congenital anamolies, genetic and neuromotor disorders were excluded from the study. The recruited infants were evaluated at 4 months, 6months and 8months of corrected age as per the instructions in the Movement Assessment of infants scale manual and scores were recorded on the MAI profile score sheets by the principal investigator. A cut-off score of ≥10 was considered as risk for neuromotor development. Then the neuromotor outcome evaluation at 12 months of corrected age was done by clinical psychologist using the motor component of Bayley Scale of Infant Development (BSID II), a gold standard tool for neuromotor assessment and a score of ≤ 84 was considered as abnormal neuromotor development. RESULTS-The predictability of MAI at 4,6 and 8 months with cut off score of 10 was measured in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).For predicting neuromotor outcome at 12months on motor items of BSID-II the estimates of sensitivity of MAI at 4,6 and 8 months was 82.3%,47.1% and 82.3%, Specificity was 74.4%,93% and 95.3%, Positive Predictive Value was 56%,72.7% and 87.5% and Negative Predictive Value was 91.4%,81.6% and 93.2% respectively for risk points≥10 on MAI. CONCLUSION-The best predictive values of MAI were obtained at 4 and 8 months of corrected age indicating that MAI is a sensitive and clinically useful tool in identifying neuromotor problems in VLBW Indian infants as early as 4 months of age. KEY WORDS-MAI, Low birth weight, motor development EMAIL- [email protected]


PAEDIATRICS SECTION

DIGITAL PAPERS



COMPARATIVE STUDY ON MOTOR PROFICIENCY IN HEARING IMPAIRED CHILDREN Vs HEALTHY

CHILDREN

Atiya A. Shaikh, Aparna Sadhale DES College of Physiotherapy, Pune

AIM : To compare gross motor function and fine motor function in hearing impaired and healthy children OBJECTIVES :

• To score and compare gross motor and fine motor skills in hearing impaired and Healthy children.

• To find if there is any co-relation between age and motor proficiency scores in above mentioned groups.

PURPOSE : Studies have proved that ,cortico-cortical and cortico-thalamic loops are missing in Hearing impaired children. This may lead to faulty processing of information and inadequate performance. Thus this study was done to find if there is any reflection of inadequate vestibular function on motor proficiency in Hearing impaired children. METHODOLOGY: STUDY DESIGN: Cross sectional SAMPLE SIZE: 180 Healthy and 180 hearing impaired children SAMPLING TECHNIQUE: Random selection INCLUSION CRITERIA: Healthy and hearing impaired children between age group of 4. 6 yrs to 14.6yrs EXCLUSION CRITERIA: Children with mental retardation or any other known behavioral, cognitive, sensory, musculoskeletal, neuromuscular disorders OUTCOME MEASURE: Subtests of Bruinink’s Osterestky Test of Motor Proficiency (reliability0.84-0.87 and validity 0.4-0.91) DATA COLLECTION: 2 groups– A: Hearing Impaired children,

B: Healthy children DATA ANALYSIS: Tests used: Mann-Whitney U Test to compare test scores in both groups (A Vs B), Spearman’s Correlation Test to find correlation between age and test scores in both groups(A and B). RESULTS: There is a significant difference in total scores of Hearing Impaired and Healthy children[ P value <0.001]. There is a significant co-relation of total motor proficiency scores with age in both groups[ P value <0.001] CONCLUSION:

• Hearing impaired children significantly lack in running speed, agility, balance, bilateral co-ordination activities, upper limb speed and dexterity as compared to the Healthy children.

• They follow same trend of maturation as Healthy children.

• An individual requires all three systems (visual, auditory and somatosensory) to perform optimally.

CLINICAL SIGNIFICANCE: The findings can be used for Screening in schools, Designing Early intervention programme in normal and special schools, Rehabilitation and post rehab evaluation in special children, Job prescription and training KEY WORDS: Bruinink’s Osterestky Test of Motor Proficiency, Hearing impaired children, Healthy children, Motor proficiency EMAIL: [email protected]



EFFECT OF MULTISENSORY STIMULATION ON NEUROMOTOR DEVELOPMENT IN PRETERM INFANTS: A

PILOT STUDY

K.Parimala Suganthini, Bhamini K Rao, Divya Mohan

Dept. of Physiotherapy, MCOAHS, Manipal University, Manipal. INTRODUCTION AND PURPOSE OF THE STUDY: Preterm infants spend few days or weeks in neonatal intensive care unit (NICU). Sensory stimulation is a part of the developmental intervention. However there is contradicting evidence on the effect of multisensory stimulus on neuromotor development in preterm infants. The aim of the study was to determine the effect of Auditory, Tactile, Visual and Vestibular stimulation (ATVV) on neuromotor development in preterm infants. METHODOLOGY: Study design: Randomized controlled trial Sample population: Preterms in NICU of Kasturba Hospital, Manipal Sampling method: convenience sampling Sample size: 30 Inclusion criteria: Infants born between 28- 36 weeks of gestation with birth weight > 1000 grams Exclusion criteria: Medically unstable infants, infants on ventilator support, with congenital anomalies and diagnosed central nervous system injury. Procedure: Thirty preterm infants were randomized into control group (n=15) and study group (n=15). Study group received multisensory stimulation for 12 minute (5 sessions per week prior to discharge) which included, soft lullabies played at 50 decibel at a distance of 1 feet from the infant for 3 minutes, black and white visual stimulation card shown at a distance of 10 inches for 3 minutes, gentle stroking massage for 3 minutes and vertical and horizontal rocking for 3 minutes along with routine NICU care. The control group received the routine NICU care. Both the group received verbal home instruction on multisensory stimulation. Outcome measure: At recruitment the baseline characteristics of the preterm infants were recorded. At discharge neonates were assessed using Alberta Infant Motor Scale (AIMS) and Infant Neurological International Battery (INFANIB). Statistical test: The AIMS and INFANIB scores were statistically analyzed using independent t test (SPSS 17) RESULTS: The mean INFANIB score of control group (x= 57.2, SD= 2.27) and study group (x=60.6, SD=4.8) showed statistically significant difference (p=0.020). Although there was difference in the mean AIMS scores (control group x=2.933, SD=0.45 and the study group, x=3.533, SD=0.63), the results were not statistically significant (p=.o6). CONCLUSION & CLINICAL SIGNIFICANCE: Multisensory stimulation may have a beneficial effect on the neurodevelopment of preterm infants which was inferred from the better scores of INFANIB in the study group. The INFANIB assesses tone, primitive reflexes and position in space whereas the AIMS assesses weight bearing, posture and antigravity movement. This would have influenced their different outcome. KEYWORDS: preterm, multisensory stimulation, neuromotor development EMAIL: pari_ma_la @yahoo.co.in



EFFECTS OF SENSORY INTEGRATION ON TACTILE DEFENSIVE CHILDREN

Dr. Elizabeth J. Nimbalkar 1, Dr. Shaila Sabnis 2

1: Terna Physiotherapy College, Navi Mumbai.

2: Sancheti Institute College of Physiotherapy, Pune. INTRODUCTION:

Tactile Defensiveness refers to a pattern of observable behaviour and emotional responses which are aversive, negative and out of proportion to certain types of tactile stimuli that most people may find to be non painful. Sensory Integration is the neurological process that organizes sensations from one’s own body and from the environment and makes it possible to use the body effectively within the environment. AIMS & OBJECTIVES: To study the effects of a planned Sensory Integration program on established cases of Tactile Defensiveness. METHODOLOGY: Study Design: A clinical trial Sample Population and Sample Size: 18 ( F= 8, M= 10) Tactile Defensive children attending special schools were included in the study over a period of 1 year. Sampling Technique: Convenient Sampling. Inclusion Criteria and Exclusion Criteria:

• Children with Tactile defensiveness, who were identified by a team of Paediatricians, Occupational Therapist and Physiotherapists were taken for the study

• They were screened with the help of Tactile Inventory for Elementary Questionnaire by a cut off score of 50%.

Outcome Measures: Tactile Inventory for Elementary (TIE) Questionnaire. Data Collection & Analysis:

• The data was collected and the mean difference (d) between the pre (x) and post (y) treatment scores was found and analysed using the formula d= y-x.

• Then a mean of these scores was found

• This was followed by calculation of Standard deviation of Pre treatment scores and post treatment scores.

• Wilcoxon Signed Rank test was then applied. RESULTS: Mean scores Pre treatment were 50.44 and Post treatment were 44.5 Standard Deviation Pre treatment were 5.04 and Post treatment were 6.34 P value : Less than 0.05 CONCLUSION & CLINICAL SIGNIFICANCE:

• SI Therapy brought about a decrease in the levels of hypersensitivity to the cutaneous stimulus.

• SI Therapy proved to be helpful in treatment of Tactile Defensiveness. KEY WORDS: Tactile Defensiveness, Sensory Integration, Cerebral Palsy, Hyperactivity disorder. EMAIL: [email protected]



A STUDY ON DIFFERENT SITTING POSITIONS ON PULMONARY FUNCTIONS IN CHILDREN WITH

SPASTIC QUADRIPLEGIC CEREBRAL PALSY

B.S.Santhosh Kanna National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD)

(Ministry of Social Justice & Empowerment, Govt. of India) East coast Road, Muttukadu, Kovalam post, Chennai – 603112.

AIM & PURPOSE OF THE STUDY:

Children with spastic quadriplegic cerebral palsy have difficulty in breathing. It is noticed that their pulmonary function needs to be enhanced, especially in sitting position as the children spend lot of time in this position during activities in classroom and at home. The Aim of the study is to find out the variance in the pulmonary parameters with change in position in order to give them the advantage of improving their pulmonary functions in sitting position. METHODOLOGY: Study Design : Experimental study Population : Children with Spastic Quadriplegic cerebral palsy Sample size : 12 Setting : Laboratory setting at NIEPMD Sampling technique : Non probability Purposive Sampling technique Selection Criteria : Children with Spastic Quadriplegic cerebral palsy, having atleast

moderate intellectual functioning to understand the instructions & able to blow in the computerized spirometer and age not less than 5 years.

Inclusion Criteria: - Age between 5 to 20 years. - Both gender inclusive - Having a level of Intelligence to understand the instructions. (IQ >50) Exclusion Criteria: - Children with other disabilities like visual impairment, hearing impairment, etc., - Known untreated cardiac problems. - Children lacking sitting balance. - Children lacking blowing skills. - Non co-operative clients. Method of data collection : The children are given demonstration how to blow in the spirometer, after several trails the child is positioned in Sitting ( 90 degrees) in a chair to measure the parameters like Forced Vital capacity, Forced expiratory volume at first second, Expiratory reserve volume, Inspiratory reserve volume and Tidal volume, the same parameters are measured with the child positioned at Semi-reclined sitting position (120 degrees). RESULTS: Results indicate that there is a increase in Forced Vital capacity, Forced expiratory volume at first second, Expiratory reserve volume and Tidal volume and a decrease in Inspiratory reserve volume in children sitting in Semi-reclined sitting position ie at 120 degrees compared to children sitting in 90 degrees CONCLUSION : It is found that the pulmonary function have improved in children sitting in Semi-reclined sitting position ie at 120 degrees compared to children sitting in 90 degrees KEYWORDS: Cerebral palsy, Pulmonary functions, Positioning, Computerised spirometer EMAIL – [email protected]



EFFECT OF OROMOTOR STIMULATION IN ESTABLISHING BREAST FEED IN HIGH RISK NEONATES

Isha Parekh, Dimpy Shukla, Purvi Parikh, Nidhi Dave, Meeta Saxena(PT)

Vadodara Critical Childcare Centre K.G.P.Children Hospital,Vadodara

AIM-To study effect of Oromotor Stimulation in establishing early breast feed in high risk neonates. OBJECTIVES -PURPOSE OF STUDY-The current gold standard by WHO and UNICEF guidelines states breast feeding within 1 hour after birth as a mother and child’s right.High risk neonates from Neonatal Intensive Care Unit(NICU) lose out on benefits of mother’s milk like colostrum,decreased hospital stay and bonding due to delayed breast feeding.This study is undertaken to analyse the effects of Oromotor Stimulation given to the high risk neonate to promote earliest possible breast feeding. METHODOLOGY- a)Study design-Prospective pilot study. b)Sample population and sample size-total 60 high risk neonates,divided in study group n=30 was matched with control group n=30 for risk factors. c)Sampling technique-randomised control trial. d)Inclusion Criteria-Risk Factors:- GROUP1-Preterm (GESTATIONAL AGE 30-33WEEKS) with Low Birth Weight (1kg-2.5kg) with Respiratory Distress Syndrome. GROUP 2-Preterm (GESTATIONAL AGE 33-36WEEKS) with Low Birth Weight (1kg-2.5kg) with Respiratory Distress Syndrome. GROUP 3- Respiratory Distress Syndrome with Hypoxia. GROUP 4- Others(Hyperbilirubinemia,Meconium aspiration,Septicemia). Exclusion- Gestational Age below 30weeks, Birth Weight < 1kg, ventilated neonates. Each neonate was initially assessed for strength of suck as: (1) no sucking response-grade 0; (2) partial sucking-grade 1+ ; (3)normal sucking-grade 1++ The study group alone received Sensory Motor Oral Stimulation to oral musculature every 2 hours just before feeding in the form of i)Tactile Stimulation ii)Trigger point Stimulation. e) outcome measures-Time taken to establish breast feeding was compared between both groups. f) Data collection and analysis-Unpaired T-Test RESULTS: 1) Mean age of first assessment:Study group-1.5days,Control group-2days. 2) Strength of sucking:Study group- grade0(n=11), grade1+(n=19),Control group-grade0(n=10), grade1+(n=20), p<0.79,showing both groups well matched. 3) Means of time taken to establish breast feed: (a) Whole Sample:Study group-4.6days,Control group-13.03days,p<0.001(highly significant difference) ; (b)Comparision for each Risk Factor:- GROUP1-Study group-4.4days,Control group-12.4days,p<0.001 GROUP2- Study group-5.125days,Control group-14.11days,p<0.001 GROUP3- Study group-5.25days,Control group-12.66days,p<0.003 GROUP4- Study group-4.11days, Control group-12.77days,p<0.001 The result shows a highly significant difference. CONCLUSION AND CLINICAL SIGNIFICANCE-Study concludes Oromotor Stimulation contributes significantly in reducing time taken to achieve early breast feeding in high risk neonates.We recommend that all Neonatal Intensive Care Unit (NICU) staff and mothers be trained for Oromotor Stimulation Technique so each neonate gets benefits of mother’s milk as early as possible. KEY WORDS-Oromotor Stimulation,breast feeding ,High Risk Neonates. [email protected]



THE ROLE OF THE PHYSIOTHERAPIST IN THE PROVISION OF SPECIALIZED SEATING FOR CHILDREN WITH

CEREBRAL PALSY IN A COMMUNITY BASED REHABILITATION SETTING

P.Darwin Victor

Mobility India, 1st & 1st ‘A’ Cross, J.P. Nagar, 2nd phase, Bangalore – 560078. BACKGROUND: Research states that the global prevalence of cerebral palsy is 2.0-2.5 per 1000 live births (Stanley et al, 2000). Cerebral palsy is a congenital neurological disorder which presents with movement and coordination impairments (Dodd et al, 2002). Consequently, many children present with impaired neck and trunk control, postural abnormalities and musculoskeletal deformities. Due to this, most of these children spend much of their time in lying positions in their home. Often, they are dependent on their parents for activities of daily living and functional activities and are segregated from family members and the community. METHODS: Mobility India, Bangalore is a non-governmental organization which provides rehabilitation for adults and children with disabilities in urban and rural settings. Its community based rehabilitation programme supports 23 slums in Bangalore and 80 villages in rural project. The service of Mobility India involves the provision of specialized seating for children with neurological impairment. The role of the physiotherapist involves prescribing and modifying specialized seating according to the requirement of the patient. A single case study was undertaken in a child with cerebral palsy, who was provided with specialized seating in 2009 .The child was receiving regular physiotherapy intervention from a physiotherapist and rehabilitation therapy assistants. She was also receiving input from community facilitators and volunteers within the community. The parents were interviewed in 2010 and asked about their opinion of the effect of the specialized seating in the following areas: transfers, postural control, oromotor control, visual interaction, hand function, behavioral changes, social interaction and activities of daily living. RESULTS AND CONCLUSION: This case study suggests that the child with cerebral palsy benefited from the use of specialized seating in a community based rehabilitation setting. Specialized seating provides postural support and has a positive effect in all of the areas explored in the case study. The physiotherapist plays a vital role in prescribing and modifying specialized seating. KEY WORDS: Physiotherapist, cerebral palsy, specialized seating, community based rehabilitation. Reference List

1. Stanley F, Blair E, Alberman E, cerebral palsies: Epidemiology and causal pathways. Clinics in Developmental Medicine, 2000, No.151, London: Mac Keith press.

2. Dodd KJ, Taylor NF, Damiano, DL. A systematic review of the effectiveness of strength training programmes for people with cerebral palsy. Arch Phys

Med Rehabil 2002; 83: 1157-64. E-MAIL: [email protected]


ELECTROTHERAPY SECTION

PLATFORM PAPERS


ABSTRACT NO 34 (ELECTRO 1)

THE COMBINED EFFECTS OF ISCHAEMIC COMPRESSION AND ULTRASOUND THERAPY ON MYOFASCIAL TRIGGER

POINTS IN UPPER TRAPEZIUS MUSCLE

Sakar Sharma1, U.T. Ifthikar Ali2

1: Amar Jyoti Institute of Physiotherapy, University of Delhi, Delhi. 2: Dr. M. V. Shetty College of Physiotherapy, Mangalore.

PURPOSE OF THE STUDY: Myofascial Trigger points (MTrP) have been clinically described as discrete areas of muscle tenderness in which widespread or regional muscular pain is associated with hyperalgesia, significant restriction of daily functioning. Many studies have been done to see the effectiveness of ultrasound combined with other physical therapies include hot packs, active range of motion, TENS, interferential therapy on MTrP’s and shows the positive effect of combination in reducing pain from MTrP’s. But studies that prove the combined effect of ultrasound and ischemic compression on the MTrP’s sensitivity have not been done so far. This study has been designed to evaluate the combined effects of ultrasound and ischemic compression on MTrP’s pain sensitivity in upper trapezius muscle. METHODOLOGY: A) Study design – Comparative. B) Sample population – total of 60 subjects diagnosed with atleast one trigger point in upper trapezius (presence of palpable taut band in upper trapezius muscle, presence of local twitch response) from the physiotherapy outpatient department of Govt. Wenlock Hospital & Dr.M.V.Shetty Hospital of Mangalore. C) Sampling method – Patients were divided, using random sampling method into Group A (control group) where subjects underwent treatment of ultrasound therapy alone and group B (experimental group) was treated with ultrasound therapy and ischemic compression, for 10 days for both the groups. D) Outcome measure – visual analogue scale and pressure algometer used for pain pressure threshold. E) Method of data collection and statistical test used - Pre and post treatment readings on day 1, 5, 7 and 10 were recorded on visual analogue scale and algometer. Raw data was analysed using student “t” test to identify the statistical significance. RESULT: The data obtained was analyzed using‘t’ test. Both groups demonstrated marked improvement in pain intensity on VAS and pain pressure threshold on algometer post intervention (P = 0.000). The mean value of difference on visual analogue scale of pre v/s post test in group A and group B was 1.33 and 3.50 respectively. The mean value of difference on algometer of pre v/s post test in group A and group B was 1.350 and 3.933 respectively which shows that there was high statistical significant improvement in group B than group A. CONCLUSION & CLINICAL SIGNIFICANCE: Both groups have showed improvement with respect to pain on VAS and PPT on algometer. The descriptive analyses suggested more improvement for the participants treated with ultrasound and ischaemic compression compared to that of ultrasound alone. Ultrasound and Ischemic Compression is more effective therapeutic techniques and their combined effect was found to be reliable in patients with MTrP’s in upper trapezius muscle. KEYWORDS: Myofascial Trigger Points, Therapeutic Ultrasound, Ischemic Compression, Upper Trapezius. EMAIL: [email protected]



IS ULTRASOUND EFFECTIVE IN THE TREATMENT OF BREAST ENGORGEMENT?

Madhuli Gosavi1, Dr. Vanita Kalbande2, Dr. Keerthi Rao3

College Of Physiotherapy, Pravara Institute of Medical Sciences, Loni-413736. AIM: To compare the effects of ultrasound treatment and sham treatment in treating post partum breast engorgement. PURPOSE: Post partum breast engorgement is a common problem associated with mild pain which sometimes becomes severe with blocked milk ducts, feeding difficulties & a depressed milk ejection reflex, so in order to relieve these signs and symptoms as early as possible there was a need to know the effectiveness of ultrasound and sham treatment on this conditions METHODOLOGY:

Study design- Cross sectional study. Sample size - 30 women Sampling technique- Simple random sampling Inclusion- 1) Post partum women with bilateral breast engorgement. 2) Age group: 16-30 yrs. 3) Primigravida women.4) Women with full term normal delivery.

Exclusion-1) Women who previously received breast implants. 2) Women having prior breast problems like breast surgery & fibrocystic disease. 3) Women having h/o of breast cancer. Procedure: Subjects were assigned in 3 groups; Group: A- Received US for right breast & no treatment for left, Group: B -Sham US for right breast & no treatment for left and Group: C-US for right breast & sham for left. Pre treatment outcome measures were collected and treatment was given 1 hr before breastfeeding and post treatment outcome measures were noted.

Outcome measure: Numerical pain rating scale, 6 point engorgement scale. Data collection & analysis: Pre scores of Numerical pain rating scale and 6 point engorgement scale of each group i.e group A(received US on right and no treatment on left) group B(received shamUS on right and no treatment on left) and group C(US on right and sham US on left) were compared and anaylsed

RESULTS: There was significant difference found in both the breasts in group A(mean diff 3.2+0.16)(p<0.05),and similar results were found in group B(mean diff 3.8+0.21)(p<0.05) and group C showing more effect of ultrasound over sham treatment(mean diff 1.8+0.04) (p< 0.05) CONCLUSION: Both Ultrasound and sham treatment are effective in reducing subjectively perceived pain and hardness. CLINICAL SIGNIFICANCE: Ultrasound should be used in cases of post partum breast engorgement. KEY WORDS: Breast engorgement, Breast feeding, Pain, Ultrasound treatment EMAIL: [email protected]



EFFECT OF PULSED ULTRASOUND IN REDUCING PAIN DUE TO INFLAMATORY SYNOVITIES AND IMPROVING R.O.M. IN POST OPERATIVE TOTAL KNEE REPLACEMENT PATIENTS.

Dr. Alpa Purohit, Dr Dilip Patel, Dr H.P.Bhalodiya

AIMS-Ahmedabad Institute of Medical Science, Lapkaman, Ahmedabad AIMS & OBJECTIVES:- To find out the effect of low frequency pulsed ultrasound in relieving patients discomforts , pain & improving R.O.M. and functions. PURPOSE:-To find out the effect of pulsed ultrasound in relieving patients discomforts, pain & improving R.O.M. and functions METHODOLOGY:- Study Design:-Pre –Post experimental study was conducted Sample Population And Sample Size- 20 females operated Total knee replacement patients were included operated by same surgeon from civil hospital and sterling hospital Ahmedabad. Sampling Technique:-Convenient sampling according to selection criteria. Inclusion Criteria:- 1)VAS more than 5, 2)Operated T.K.R. with high flex joint by same surgeon, 3)Pre operative fixed flexion deformity <10, 4) Post operative 2 months, 5) Post operative R.O.M. 0- 90° to 0-100°, 6) Midline incision, 7)Average age 55-60,female, 8)BMI >30 Exclusion Criteria:- 1) Vas less than 5, 2) Operated T.K.R. with other prosthetic joint, 3) Pre operative fixed flexion deformity >10°, 4) Post operative phase less than 2 months, 5) Post operative R.O.M. less than 90 degree & more than 100 degree, 6) Other than midline incision, 7)Age more than 60 & less than 55yr, 8) BMI <30 Outcome Measures:- VAS-visual analogue scale for pain ,R.O.M.,WOMAC- index were taken pre treatment and post treatment. Data Collection & Analysis:- Data were collected from civil hospital and sterling hospital ahmedabad at post operated 2 months of surgery .Along with conventional treatment low frequency pulsed ultrasound was given for 5 minutes - 10 days continuous treatment .Outcome parameters were analysed pre treatment & post treatment. Statistical analysis was done with student’s t-test. RESULTS:- Data was analyses by using Paired t-test . It showed t-value for VAS, R.O.M &WOMAC are 18.38,13.639 and 15.73 respectively which showed highly significant(p<0.001) level. CONCLUSION:- Results shows that low frequency pulsed ultrasonics is effective in reducing pain & discomfort due to inflamatory synovitis & improving R.O.M and functions. in T.K.R. KEY WORDS:-Ultrasound,T.K.R.,Pain, Synovities E-MAIL: [email protected]



COMPARISON BETWEEN CRYOTHERAPY ALONE AND CRYOTHERAPY WITH EXERCISE ON MAXIMAL ISOMETRIC

CONTRACTION OF THE HAND.

Dr. Sheetal Shailesh Jain, Dr. Vibhuti Soni, Ronika Agrawal MME & RC’s M. A. Rangoonwala College of Physiotherapy and Research, Pune.

AIM: To study the effectiveness of Cryotherapy alone and Cryotherapy with exercise on, maximal isometric contraction of the hand. OBJECTIVE: To study the effectiveness of Cryotherapy alone and Cryotherapy with exercise on maximal isometric contraction of the hand immediately after, at 15th minute, at 30th minute and at 45th minute. PURPOSE OF THE STUDY: Cryotherapy has long been introduced as a common therapeutic method in treating musculoskeletal injuries. It has been promoted for its beneficial effects on pain, muscle spasm, reduction of secondary injury and muscle strength. The purpose of the study can hence be concluded ,is to study the effectiveness of cryotherapy alone and cryotherapy and exercise on maximal isometric contraction of the intrinsic muscles of the hand. METHODOLOGY: Study design: Comparative cross sectional interventional. Sampling technique: Convenience Sample size: 50 subjects. Inclusion criteria: Individuals within age group 18-25 yrs {both males and females}, more than grade 4 strength/ full range of motion/ intact sensation and skin of the upper extremity. Exclusion criteria: Any injury/surgery/diminished sensation/muscle wasting/ulceration or open wound over upper limb, Pathological conditions like Raynauds Phenomenon/ Cardiac Diseases, Emotional and psychological features. Outcome measure: Grip strength in kilogram force using Hand-held Dynamometer. Data analysis: Repeated Measures Analysis of Variance (ANOVA), independent‘t’ test Data collection: Group 1: Cryotherapy alone (15 minutes) Group 2: Cryotherapy (15 minutes) followed by exercise (10 minutes). Grip strength was measured at: Preimmersion→immediately after immersion/exercise→ 15th minute→at 30th minute→ at 45th minute. RESULTS: Group 1: The grip strength immediately post immersion significantly decreased below the pre immersion values (p =.032) and increased significantly at 15th minute (p = 0.002) above the pre immersion values and have remained almost constant at 30th (p = .002) and 45th minute (p = .043). Group 2: The grip strength showed no significant change immediately post immersion and immediately after exercise. The values showed a slight decline at 15th minute but increased significantly above the prebaseline at 30th (p = .001) and 45th minute. CONCLUSION AND CLINICAL SIGNIFICANCE: Maximal isometric strength decreases or shows no change immediately after cryotherapy but increases after 15 minutes which is retained for a long time. The strength changes, when given in combination with exercise have a variable effect. The increments and decrements in the strength following cryotherapy may adversely affect the athlete’s performance. Clinicians should consider these changes during musculoskeletal rehabilitation. KEY WORDS: Cryotherapy, Maximal isometric contraction of hand, Grip strengthening exercises. EMAIL: [email protected]



EFFECT OF STRENGTHENING VERSUS BIOFEEDBACK ON GRIP STRENGTH

Dr. Rubina Poonawala, Dr. Shakeel Ahmed, Dr. Ronika Agrawal

MME & RC's M. A. Rangoonwala College of Physiotherapy and Research, Pune. AIM: To compare effects of strengthening grip muscles with Theraband Gel ball versus effects of auditory and visual feedback while grip strength testing. OBJECTIVE: To quantify effect of strengthening dominant hand with Red XL theraband gel ball, the effect of verbal encouragement and visual feedback on grip strength measurement , and to compare weekly difference in grip strength in both groups. PURPOSE OF STUDY: There is strong evidence of modalities like theraband gel balls being used for grip strengthening, and also studies which prove the efficacy of biofeedback in grip strengthening. However evidence comparing the two is lacking. METHODOLOGY: Study design: Pre-post experimental study Sample population: Males and females within age group of 18-25 Sample siz: 30 individuals in 2 groups of 15each. Group A - underwent strengthening protocol. Group B - visual and auditory feedback during grip strength testing with Jamar dynamometer Sampling technique: Simple random sampling Inclusion Criteria: Normal healthy males and females age 18-25 years Exclusion Criteria: Pain, stiffness, inflammatory joint disease, injury/fracture of dominant upper limb, neurological involvement. Outcome Measure: Grip strength in kilograms force Data Collection :After initial grip strength testing, Group A: Strengthening with Theraband gel ball - 3 sets, 15 repetition/ set, 5 second hold each repetition, 6 days/ week for 3 weeks Group B: Verbal encouragement to get a higher value than previous and motivation given during testing. No strengthening. Grip strength was measured for both groups at end of each week for 3 weeks RESULTS: Group A: Shows continuous increase in grip strength over 3 weeks, with greater increment after 1st week (p-0.005) and 3rd week reading (p-0.001) Group B: Definite increase in grip strength after 1st week, small increment in 2nd week, and plateauing at 3rd week which reflects maximal effort at inherent strength. Also no significant difference between the 2 groups (p-0.400) when mean difference between 3rd week and baseline reading is taken. CONCLUSION AND CLINICAL SIGNIFICANCE: There is approximately same increase in grip strength for both groups when compared between baseline and 3rd week values. Verbal encouragement and visual feedback can play an equally important role to improve grip strength. However resisted exercises, unlike biofeedback, elicit physiological adaptations that may form the basis of enhanced performance, reduction in injury risk and pain status. Biofeedback is likely to recruit stronger muscles rather that weaker muscles. KEY WORDS: Grip strength, Biofeedback, Jamar Dynamometer, Theraband gel ball EMAIL: [email protected]



LOW LEVEL LASER THERAPY IN ACUTE DEHISENCE- A THERAPEUTIC PROPOSAL

Hardik Parab, Arun G.Maiya, Snehil Dixit, Dixit Sweta B.

Department of physiotherapy MCOAHS, Manipal University, Manipal

AIM OF THE STUDY: Surgical wound infection remains a major problem in cardiac surgery and occurs mainly after full sternotomy. Further risk factor analyses have revealed diabetes, hypertension, hyperglycemia, obesity, smoking, elderly to be associated with the deep sternal wound infection. The aim was to evaluate the response of laser therapy in deep sternal wound infection post coronary artery bypass grafting. OBJECTIVE OF THE STUDY: Although a variety of treatment algorithms has been advocated the case report was undertaken to evaluate the effect of low level laser therapy post CABG dehiscence. . PURPOSE OF THE STUDY: Literature regarding action of low level laser therapy on post operative wound dehiscence is scarce METHODOLOGY: The case report of two patients 56 year old (A) and 48 year old (B) in whom mid line sternal dehiscence developed after uncomplicated coronary artery bypass grafting at Kasturba Hospital Manipal. Laser therapy was started from them on 31st August and was given for 15 days for 36 minutes with the portable laser and a pressure ulcer scale for healing (PUSH score) and photography were taken regularly for both the patients and was categorized and marked according to the surface area, exudates, and type of wound tissue. A comparison of the total score measured over time provided an indication for the improvement or the deterioration of the healing of wound tissue. RESULTS: The non healing surgical site infection showed a significant improvement in appearance of granulation tissue, decreased exudation amount, reduction of surface area and faster healing with the use of the low level laser therapy. CONCLUSION: In this case report the importance of biomodulation in dehiscence post CABG surgical site infection was confirmed signaling a new proposal for non invasive, effective and safe treatment. KEY WORDS: Low level laser, Healing, Post CABG, Dehisence, Infection EMAIL: [email protected]



USEFULLNESS OF H-REFLEX STUDY IN DIAGNOSIS OF PIRIFORMIS SYNDROME

Dipali N. Gohil, Dr. Yagna Shukla

Govt. Physiotherapy College Ahmedabad

INTRODUCTION: Piriformis Syndrome consist of symptoms arising due to entrapment of sciatic nerve (one or both division) as they pass the sciatic notch. The painful symptoms and dysesthesias of Piriformis Syndrome are frequently exacerbated by adduction, internal rotation and flexion (AIF position) on affected leg. The H-reflex is an electrically stimulated version of Achilles reflex. The H-reflex crosses the piriformis muscle twice – in afferent and effernt orthodromic conduction. PURPOSE OF STUDY: To find out weather H-reflex can be used as an aid for diagnosis of Piriformis Syndrome. METHODOLOGY:

a) Study design : Observational Study b) Sample size : 15 patients was taken matched with inclusion and exclusion

criterias. 15 healthy subjects were taken. c) Sampling technique : Convient sampling d) Study setting : The study was conducted at Govt. Physiotherapy College,

Civil Hospital, Ahmedabad, Gujarat. e) Procedure : H-reflex was obtained from soleus muscle. First it was taken in

anatomical prone position and then AIF ( hip in Adducted maximally, Internally rotated and Flexion) position.

f) Inclusion criteria : 1) Positive lasegue sign at 45° 2)Tenderness at sciatic notch

3) Increase pain within the distribution of sciatic nerve in the AIF position Exclusion criteria : 1) Radiculopathy 2) Peroneal nerve palsy 3) Neuropathy and myopathy

e) Outcome Measure : H reflex latency was used as outcome measure. f) Data collection and analysis : Data collection was done using H- latency. Mean and SD were calculated and t test was applied. RESULTS: Paired t test was used to compare affected and non affected legs for 15 patients with Piriformis Syndrome with normal contralateral leg. The Mean delay of H-reflex for 15 patient with Pirifornis Syndrome was 2.66 msec. The Mean H-reflex delays for 15 normal contralateral legs and 15 subjects from control group were 0.82 msec and 0.07msec, respectively. CONCLUSION AND CLINICAL IMPLICATION: The technique presented here estimates a functional entrapment of sciatic nerve electophysiologically. Use of H-reflex may provide a simple, non-invasive aid to differential diagnosis of Piriformis Syndrome. KEY WORDS: H-reflex, Piriformis Syndrome EMAIL: [email protected]



COMPARISON OF SHORT TERM EFFECTS OF ELECTRICAL STIMULATION OF SPASTIC AGONIST AND ANTAGONIST

MUSCLES IN MODULATING SPASTICITY

Divya Mohan, Akanksha Singh, Aditya Krishnan

Department of Physiotherapy, MCOAHS, Manipal University, Manipal AIM: To compare short term effects of Faradic Electrical Stimulation on spastic agonist and antagonist muscles in modulating spasticity. OBJECTIVE: To measure the tonal changes after electrical stimulation to spastic muscle and it's antagonist. METHOD:

a) Study design- Cross over study b) Sample population- Six c) Sampling method- Convenience sampling d) Outcome measure- Modified Tardieu Scale e) Method of data collection- 48 patients was screened, of which 8 met the

inclusion criteria. 2 subjects were excluded due to medically unstable condition. Acute or chronic stroke cases with spasticity of biceps/triceps were included for the study. Modified Tardieu Scale (MTS) was used to grade spasticity. Grading of the spastic muscle group was not more than 3 on MTS for the selected patients. Functional Electrical Stimulation machine with electro motor stimulation mode (Mega XP, model no. CMMX-001A, manufacturer Cybermedic Co-operation) was used to provide electrical stimulation to spastic muscle and its antagonist at a minimum interval of 24 hours to prevent carry over effects. Stimulation parameters for agonist muscle: pulse frequency (PF) 30 Hz, pulse width (PW) 300 µs, for antagonist muscle: PF 50 Hz, PW 250 µs. Ramp up, hold time, ramp down, relaxation period kept same for both muscle groups 3sec, 4sec, 3 sec and 5 sec respectively.

f) Statistical test used: Wilcoxon Signed Ranked Test. RESULTS: MTS median- 2, Agonist- Pre R1(92.5° ± 22.29°) Post R1( 114° ± 11.65° ), p value-( Post R1 – Pre R1 0.027), Pre R2 (127° ± 23.8°) Post R2 ( 140.5° ± 17.22° ) p value- ( Post R2- Pre R2 0.046 ) , Antagonist- Pre R1( 115.3° ± 32.6° ),Post R1 ( 126.2° ± 26.8° ), p value- ( Post R1– Pre R1 0.043) Pre R1 ( 133.7° ± 23.4° ), Post R2 ( 139.2° ± 24.8° ), p value- ( Post R2 – Pre R2 0.066). There was no significant difference between changes noticed in R1, R2 and R2-R1 values recorded prior to and after stimulation for agonist (spastic) muscle and the antagonist one. CLINIAL SIGNIFICANCE: Change in R1 (at V3- fast velocity movement) and R2 (at V1- slow velocity movement) seen for both muscle groups, more for agonists. This could be indicative of reduction of neural aspect of spasticity possibly more by stimulation to spastic agonist group. KEYWORDS: spasticity, electrical stimulation. E Mail: [email protected]



SURFACE ELECRTOMYOGRAPHIC ANALYSIS OF LOWER SERRATUS ANTERIOR IN THREE DIFFERENT TEST

POSITIONS

Swati M. Surkar 1, Dr. Swati Meshram2

1: P. T. School and Center, Seth G.S.M.C & K.E.M. Hospital, Mumbai 2: Terna Physiotherapy College, Navi Mumbai

BACKGROUND: Serratus anterior muscle is a very important scapular protractor and upward rotator. Studies have shown that upper part is more suited for protraction and lower part for upward rotation of the scapula. Maximum activity of serratus anterior during upward rotation and protraction of scapula shows conflicting evidences. It’s found that during active elevation of the arm in the plane of the scapula, EMG activity of the lower serratus anterior progressively increases. Ekstrom found that resisted arm elevation above 1200 in various planes produced maximum activity in the lower serratus anterior PURPOSE OF THE STUDY: Manual muscle testing is utilised in clinical setting to determine muscle function and strength of Serratus Anterior. But there are conflicting evidences regarding the maximum recruitment of lower serratus anterior in standardise test positions. Hence purpose of the study was to determine whether activity of lower serratus anterior differ during different isometric muscle tests. OBJECTIVES: To identify the test position that elicits the greatest level of EMG activity in lower serratus anterior among three different test positions i.e. 1.Scapular protraction in 1200 shoulder flexion in the plane of scapula in sitting 2. Scapula protraction in 900 shoulder flexion in plane of scapula in sitting 3. Wall push up in standing

METHODOLOGY a. Study Design: Prospective single group repeated measures design b. Sample size: 20 healthy male subjects c. Sampling technique: Non randomized sampling d. Inclusion Criteria: Healthy young adult males having BMI below 25. e. Exclusion Criteria: Subjects having neuro-musculoskeletal impairments such

as pain, weakness, instability and impingement f. Outcome Measures: Electromyographic activity i.e. Maximum Isometric

Voluntary Contraction (MIVC) of lower serratus anterior. DATA COLLECTION: Twenty healthy males with mean age group of 22.5 years participated in the study based on inclusion and exclusion criteria. EMG data was collected for each subject from lower part of serratus anterior on dominant side in three different test positions and data was analysed. Statistical Analysis: Repeated measures ANOVA RESULTS: Scapular protraction in 1200 shoulder flexion in the plane of scapula in sitting demonstrated significantly greater activity in lower serratus anterior among 3 test positions. CONCLUSION AND CLINICAL SIGNIFICANCE: Scapular protraction in 1200 shoulder flexion in the plane of scapula in sitting can be used for maximum recruitment of lower serratus anterior. KEYWORDS: Surface EMG, Serratus anterior, test positions EMAIL: [email protected]


ELECTROTHERAPY SECTION

DIGITAL PAPERS



ELECTRICAL STIMULATION AND THERAPEUTIC ULTRASOUND AS AN ADJUNCT TO TREATMENT OF

DIABETIC ULCERS- A SYSTEMATIC REVIEW

Prakruti J Patel, Dr. A G Maiya

Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal OBJECTIVE: Electrical stimulation and ultrasound have been recommended as an adjunct to treatment of diabetic ulcers. However, the evidence regarding of the effectiveness and clinical guidelines of these therapeutic interventions has not been clearly established. Thus the objective of this study is to review the literature on effectiveness of electrical stimulation and therapeutic ultrasound on healing of diabetic leg and foot ulcers METHODS: Study Design: Systematic review Search Strategy: A search was made for studies on effectiveness electrical stimulation and ultrasound in treatment of diabetic ulcers from PubMed, ProQuest, Cochrane database, ScienceDirect and CINHAL databases. Study Eligibility Criteria: All full text randomized controlled clinical trials in English language published in the past ten years with diabetic ulcers and electrical stimulation or ultrasound therapy as an adjunct to primary treatment were included. DATA ANALYSIS: Quality of each article was assessed using Structured Effectiveness Quality evaluation Scale (SEQeS) for 4 articles with electrical stimulation and 1 article with therapeutic ultrasound. Rating was done by two people and the difference in points was adjudicated. RESULT: 14 articles were screened of which 4 articles on effect if electrical stimulation and 1 article on effect of ultrasound therapy met the inclusion criteria. Primary outcomes used were proportion of healed ulcers, ulcer surface area and ulcer appearance. A total of 352 participants in 5 studies were enrolled. Main inclusion criteria were, patients with type I or II diabetes having chronic leg or foot ulcers. Types of intervention used were:

1. Alternating Constant Current, square wave pulses (pulse width 1ms) 2. Symmetric and non- symmetric biphasic stimulation 3. High – voltage pulsed galvanic stimulation 4. Frequency rhythmic electrical modulation 5. Non- contact 20-40 kilohertz ultrasound therapy

Since all the studies used different types of currents pooling of data was not done. CONCLUSION: Non contact therapeutic ultrasound at the frequency of 20-40 kilohertz , intensity 0.1- 0.5 watts/ cm 2 for 4 minutes shows clear conclusive evidence of enhancing wound healing in distal lower extremity diabetic ulcer management. On the other hand, electrical stimulation appeared to have positive effects in healing of diabetic ulcers however; many studies were of poor- moderate quality and at high risk of biases. Due to heterogeneity of the currents & outcome measures used and inadequate description of methodology conclusive evidence is hard to establish. KEY WORDS: foot, diabetes, stimulation, chronic wound EMAIL: [email protected]


ABSTRACT NO 130 (ELECTRO 8) DIFFERENCE IN CHANGE IN MOTOR AND SENSORY NERVE CONDUCTION OF MEDIAN NERVE BY ICE PACK AND COLD

WATER IMMERSION

Foram Dhebar, Dr. Megha Sheth, Dr. Neeta Vyas

S.B.B. College Of Physiotherapy, Ahmedabad, AIM: To compare the effect of ice pack and cold water immersion on the nerve conduction parameters of median nerve in healthy young individuals. PURPOSE: Cryotherapy is the therapeutic application of ice which reduces tissue temperature, blood flow, and cellular metabolism. It also reduces conduction velocity in sensory and motor nerves. These physiological changes lead to therapeutic effects such as reduction in pain and muscle spasm. Different techniques are available for application in which ice pack and cold water immersion are commonly used. Hence the study was done to compare the effect of both modalities METHODOLOGY: Study design: Experimental study. Sample size: 10 subjects in both groups. Sampling technique: simple random sampling Inclusion criteria: healthy normal males and females aged 18 to 25 years Exclusion criteria: history of alcoholism or smoking, peripheral vascular or cardiovascular disease, diabetes, neurological or musculoskeletal disorder, recent trauma or injury to right hand, local hot and cold insensitivity, Reynaud’s phenomenon Outcome measures: Motor and sensory NCV and CMAP and SNAP amplitudes of Right Median Nerve Data collection: 10 young healthy individuals were randomly selected and divided into 2 groups. The procedure was explained and written informed consent was taken. Ice pack was applied over right wrist for 15 minutes. For cold water immersion, the right hand as far as right wrist was immersed for 15 minutes. Group A was given ice pack on day1and immersion on day2. Group B was given immersion on day1 and pack on day2. CMAP and SNAP resulting from stimulating right median nerve were recorded from wrist before and immediately after therapy. Paired t- test was applied for comparison of within group and between group differences using Graph pad. Level of Significance was kept at 5 % RESULT: Statistically significant difference was found in MNCV and SNCV (t=5.765, t= 4.270, p<0.05) for ice pack and for cold water immersion groups (t= 6.91, t=6.60, p<0.05) respectively. Statistically significant difference was found in MNCV and SNCV (t=2.33, t=2.57, p< 0.05) between the groups. A reduction in amplitude and increase in latency and duration of compound action potential (motor, sensory) was also seen. CONCLUSION: Both modalities are effective, but immersion is more effective in decreasing NCV at a physiological level CLINICAL SIGNIFICANCE: The result suggests that cold water immersion is more indicated than ice pack for inducing therapeutic effects. KEYWORDS: ice pack, cold water immersion, nerve conduction study. EMAIL: [email protected]



EFFECT OF PEME AND STRETCHING V/S STRETCHING ALONE ON HAMSTRING FLEXIBILITY IN YOUNG HEALTHY

FEMALES

Falguni D. Patel, Dr. Megha Sheth, Dr. Neeta Vyas S.B.B College of Physiotherapy

AIM: To compare the effects of low load, short duration stretching with and without PEME on hamstrings flexibility. PURPOSE: The purpose of study is to determine use of PEME with stretching produces increases hamstrings flexibility that can be retained longer than static stretching alone. METHODOLOGY: Study design: randomized control trial Sample population and sample size: 30 young healthy females, Sampling technique: random sampling Inclusion criteria: Young healthy females from S.B.B. college of physiotherapy aging 19 to 25yrs with tight hamstrings in right lower limb. Tightness was tested by active knee extension test with hip flexed at 90 degrees. Exclusion criteria: Any recent injuries or #s around right hip or knee region, Subjects having abnormal temperature sensation, Acute pain with joint movement and muscle elongation. Outcome measures: ROM of right knee extension, by performing Active Knee Extension Test Data collection and analysis: 30 subjects from S.B.B. college of physiotherapy were included in the study. Considering inclusion and exclusion criteria subjects were divided into three groups. GROUP A: PEME and stretching. 10 subjects GROUP B: sham PEME and stretching. 10 subjects. GROUP C: stretching alone. 10 subjects. Hamstring flexibility was tested by active knee extension test with hip flexion at 90 degrees before and after the treatment. Treatment was given for 5 days and then retesting of length of hamstrings was taken on 8th day. In GROUP A, PEME was given at 1125Hz pulsed frequency, 95 us pulse width, 10 watts of output for 15 minutes with use of thermoplode 140. In GROUP B, subjects with sham PEME and stretch group followed the same protocol, with PEME unit turned off. IN GROUP C, 3 sets of stretch given. Stretching of hamstring on the right lower limb performed on all the three groups for 3 sets of 30seconds before being retested. Data was analyzed using ANNOVA with SPSS. RESULT: Mean increases in knee extension range after 8 days treatments were, in GROUP A 24.4 degree. In GROUP B, it is 17.5 degree. In GROUP C, it is 13.4 degree. ANNOVA shows there is no significant change in ROM of knee extension in between the groups (p<0.05) and significant changes within the group (p=0.05). CONCLUSION AND CLINICAL SIGNIFICANCE: Within the group it is significant but in between groups it is not significant. KEY WORDS: Hamstring flexibility, PEME, sham PEME. E MAIL: [email protected]


MANUAL THERAPY SECTION

PLATFORM PAPERS


ABSTRACT NO 19 (MANUAL THERAPY 3)

TO COMPARE THE EFFECTS OF MAITLAND MOBILIZATION & CONVENTIONAL THERAPY VERSUS CONVENTIONAL THERAPY IN

CASE OF LUMBER RADICULOPATHY

Edrish S. Contractor Ahmedabad Institute of Medical Sciences

AIMS & OBJECTIVE: To study the effectiveness of Maitland Mobilization & Conventional Therapy Versus Conventional Therapy alone in relieving pain and increasing Functional Status. Purpose of the Study: To study the effectiveness of Maitland Mobilization in relieving pain and increasing Functional Status. METHODOLOGY: Study Design: An Experimental study was conducted to find the effectiveness of Maitland Mobilization & Conventional Therapy versus Conventional Therapy alone in relieving pain and increasing Functional Status. Study Setting: This study was conducted in Paraplegia Hospital, Civil Hospital Campus, Ahemedabad. All the patients were referred from Orthopaedic Out patient Department, Civil Hospital, Ahmedabad. Sample Selection: The convenient sample size consisted of 30 (Thirty) patients who were diagnosed with Lumbar Radiculopathy, as per the Inclusion Criteria and Exclusion Critieria Inclusion Criteria: Patients diagnosed with the Lumbar Radiculopathy ( All Chronic Cases), Age Group :- 35 - 55 years, Patients who are able to comprehend commands, Willingness to Participate. Exclusion Criteria: Acute cases, Sudden Onset, Prolapsed Intervertebral Disc (Type III & IV), Neurological Claudification, Previous spinal surgery, Recent motor vehicle accident Sample Duration: The total duration of study was 12 months. The patients were treated for a period of 2 weeks, 6 days a week, one session daily. Sample Size: Group A: 15 patients, Group B: 15 patients, Both Sexes, Male: 12, Female: 18 Outcome Measure: Visual Analogue Scale for Pain, Modified Oswestry Back Index Scale for Functional Disability Procedure: Group A was given Maitland Mobilization technique and Conventional Therapy. Subjects assigned to this group were treated by the “mobilization” techniques for the lumbar spine that passively move an intervertebral joint within or beyond its existing range of movement, described by Maitland. Maitland mobilization (Grade I, II, III, 1V) techniques refer to the application of Oscillatory/Gliding techniques. Group B was given Conventional Therapy alone with IFT, Lumber Traction & Back Exercise. Method of Data Collection: Data was collected at baseline, 1 week, and 2 weeks at discharge. Statistical Test: Wilcokson Sign Rank Test RESULTS: The results were analyzed by Wilcokson Sign Rank Test. Comparison of Group A and Group B was done with Wilcokson Sum Rank Test. Group A showed significant improvement in Pain (X2 = 17.89, p =0.05), and Functional Disability (X2 = 31.3, p=0.05). CONCLUSION: Maitland Mobilization along with Conventional Therapy showed significant improvement in Pain as seen in VAS Scale Score & also improved Functional Disability Thus it can be concluded that Maitland Mobilization is a useful adjunct therapy in treating Lumbar Radiculopathy. KEY WORDS: Lumbar Radiuclopathy, Maitland Mobilization, Conventional Therapy. EMAIL: [email protected]



EFFICACY OF MULLIGAN MANIPULATION WITH PROPRIOCEPTIVE TRAINING IN LATERAL LIGAMENT

SPRAIN OF THE ANKLE JOINT.

Jonathan John, Malligarjun. N., Sudhan Christudas MS (ortho), DNB (ortho)

Christudas Orthopaedic Speciality Hospital & Research Institute, Chennai. AIM &OBJECTIVE: To study the effectiveness of Proprioceptive training with mulligan manipulation over conventional physiotherapy in patients with lateral ligament sprain of the ankle joint. METHODOLOGY: Study design: Experimental design Sample population: 30 patients with Grade I and II of lateral ligament sprain in either side of the ankle joint between age group 20 to 40 years (20 male and 10 female) were selected. Sample Technique: The whole sample was selected by probability sampling method. They were divided equally into study group and control group by using simple random sampling technique. Outcome measure: Visual Analog Scale for pain, Foot Ankle Outcome Score (FAOS) for functional activities and Joint position sense for Proprioception were used. Data Collection & Analysis: The primary data collection was done by observation and questionnaire method. Independent t-test was used for the statistical analysis. PROCEDURE: Initially for 2 weeks both the groups were treated with 1:1 pulsed ultrasound, active exercises and ankle binder (5 sittings per week). From 3rd to 6th week (3 sittings per week) the study group was treated with Proprioception training using balance board, wobble board, mini trampoline and Mulligan manipulation followed by mulligan taping where as the control group was treated with strengthening exercises and heel lock taping. RESULT: The analysis shows that there is highly significant improvement in the study group. The activities of daily living score (t-value 29.55), recreational activities score (t-value 15.66) and quality of life score (t-value 30.19) of FAOS were observed between study and control group at p<0.05 level. There was a significant decrease in the severity of pain (p<0.05) with t-value 2.33 in the study group as compared to the control group. Improvement in the measurement of error of Proprioception post training is highly significant in the study group (t-value 11.29) at p<0.05 level. CLINICAL SIGNIFICANCE: Our study has shown that there is a significant reduction in pain and improvement in functional activities of ankle joint with Proprioceptive training and mulligan manipulation compared to conventional physiotherapy. KEY WORDS: Proprioception, Taping, Mulligan manipulation, ankle joint. EMAIL: [email protected]



EFFECT OF NEURAL TISSUE MOBILIZATION FOR MEDIAN, RADIAL, ULNAR NERVES ON THE DOMINANT HAND GRIP

STRENGTH

Rajneet Sahni, Prof.Dr.R.Harihara Prakash

College of Physiotherapy ASIMSR, Ludhiana

OBJECTIVES OF STUDY: To study and compare the effectiveness of Median, Radial and Ulnar nerve mobilization on hand grip strength . NEED OF STUDY: There is limited evidence supporting favorable outcomes when using neural mobilization to treat specific patient population and appropriate parameters of dosage that is duration, frequency remains to be confirmed. METHODOLOGY: STUDY DESIGN: experimental study SAMPLE POPULATION: Asymptomatic Right handed dominant female students from All Saints Institute of Medical Sciences and Research Ludhiana. SAMPLE SIZE: 30 SAMPLING TECHNIQUE: Purposive Sampling INCLUSION CRITERIA: Asymptomatic right hand dominant females, Age 20-24 years, BMI- range( 18.5—24.9), Full passive and active range of motion in bilateral upper extremities EXCLUSION CRITERIA: Any systemic, neurological diagnosis affecting bilateral upper extremity, Musculoskeletal joint dysfunction affecting ROM of bilateral upper extremities OUTCOME MEASURE :Hand grip strength PROCEDURE: Since there was no review of literature supporting a proper treatment protocol for nerve mobilization, pilot studies were done. Based on the pilot study individual nerve mobilization was taken into consideration. Group A was given Median nerve , Group B Radial nerve, and group C ulnar nerve mobilization First grip strength was measured at zero session after a gap of 5 minutes nerve was mobilized. Each nerve had 3 sets of mobilization, one set lasting for 10 sec and 1 min. gap in between two sets. After mobilizing nerve a gap of 5 minutes was given and hand grip strength was measured again Neural mobilization was continued for 6 session’s .For accuracy 3 readings were taken and mean was considered for data analysis. DATA ANALYSIS : Paired T test and ANOVA were used RESULT: T test value for Radial Median and Ulnar nerve is10.52,9.58and 11.30.Table value at .05% level is 2.Therefore null hypothesis is rejected indicating that neural mobilization increases hand grip strength Increase in hand grip strength is highest for Radial (4.53) followed by Median nerve (4.12) and Ulnar nerve(3.86) mobilizations. F test table value in ANOVA is 3.35 which is more than the calculated value which is .795 therefore increase in hand grip strength is equal after mobilization of three nerves. CONCLUSION: The research supports alternate hypothesis and that nerve mobilization increases hand grip strength .Both muscular and neural component are important in order to improve the grip strength. CLINICAL SIGNIFICANCE: Since neural tissue mobilization increases hand grip strength, it can be used to strengthen hand grip along with muscle strengthening exercises. Keywords : Upper limb nerve mobilization , hand grip strength.



COMPARISON OF EFFECT OF MUSCLE ENERGY TECHNIQUE AND MYOFASCIAL RELEASE TECHNIQUE ON

UPPER TRAPEZIUS TRIGGER POINTS IN SUBJECT WITH NON SPECIFIC NECK PAIN.

Nipa Shah, Nehal Shah

S.B.B College of Physiotherapy, V. S Hospital, Ellisbridge, Ahmedabad

INTRODUCTION: Myofascial pain syndrome(MPS) is one of the common causes of neck pain, characterized by myofascial trigger point(MTrPs), which is hyperirritable spot in a taut band of skeletal muscle. Involvement of trigger point in trapezius muscle in neck pain is well established. Manual therapy has been identified as a potential means of resolving active trigger point. AIM OF THE STUDY : To compare the effects of two manual therapies, Muscle energy technique and Myofascial release technique on pain, cervical range of motion and pressure pain threshold of upper trapezius trigger point METHODOLOGY: Study design- comparative experimental study, Sample size -30 Place of research- OPD of S.B.B college of physiotherapy. Inclusion criteria: 30-55 yrs of age, having an upper trapezius trigger point, decreased cervical lateral flexion to the opposite side and non specific neck pain for less than 3 months. Exclusion criteria: Any specific causes of neck pain like trauma, PIVD, Degenerative cervical spine, shoulder joint pathology, neurological deficits involving upper limb, clotting disorders, skin conditions or open wound over upper trapezius region or cognitive dysfunction PROCEDURE: Subjects were selected and screened for exclusion criteria. Patients were randomly divided into two groups and procedure was explained. Muscle energy technique and neck exercise were given to group A . MFR and neck exercise were given to group B. Both treatments were given for the period of one week. Outcome measures were taken in form of Visual Analog Scale, PPT by pressure algometer and ROM of cervical side flexion to opposite side by goniometer on first day before treatment and on the 6th day after treatment in both the groups. RESULTS: Statistical analysis was done using student ‘t’ test. Mean reduction of VAS in group A and group B was 4.2 and 1.81(P =0.002). Mean improvement of PPT in group A and group B was 1.31 and 0.29.(P=0.001). Mean improvement of cervical lateral flexion in group A and B was 10.53 and 3.25(P=<0.001) CONCLUSION: The result of the study shows that both the groups are effective but Muscle energy technique is more effective in reducing pain and improving PPT and ROM of cervical lateral flexion of opposite side than Myofascial release technique. KEYWORDS: MET, MFR, Trapezius trigger point.



IMMEDIATE EFFECTS OF MULLIGAN’S TAPING ON INFERIOR HEEL PAIN OF PLANTAR FASCITIS USING

WEIGHT BEARING PRINCIPLE OF MULLIGAN CONCEPT MANUAL THERAPY

Dr Varoon C Jaiswal (PT), Dr Snehal Ghodey (PT), Dr Kiran Pawar (PT)

MAEERS Physiotherapy College Talegaon (D), Pune. AIM: To study the effectiveness of Mulligan’s taping technique on inferior heel pain of plantar fasciitis using weight bearing principle of mulligan concept manual therapy OBJECTIVES:

1. To assess inferior heel pain in weight bearing on Numerical Pain Rating Scale 2. To tape the calcaneum in weight bearing position (toe standing) 3. To assess inferior heel pain post taping

PURPOSE OF THE STUDY: There is strong evidence that taping can reduce the pain due to plantar fasciitis at 1 week of follow up & also when compared with sham taping& stretching. Brian Mulligan has developed his unique taping for the inferior heel pain, but there is dearth in the evidence regarding the effectiveness of Mulligan tapping on plantar fasciitis. As the complains are intensified during weight bearing, we wanted to incorporate taping in weight bearing applying the weight bearing principle of Mulligans manual therapy METHODOLOGY: Study design: quasi experimental Sample population: All patients attending Orthopedic Outpatient Department of Bhausaheb Sardesai Rural Hospital with heel pain. Sample Size: 15 Sampling technique: Convenience sampling Inclusion criteria: Diagnosed cases of plantar fasciitis (inferior heel pain) by the orthopedic surgeons, Complains of heel pain on weight bearing Exclusion criteria: Skin allergy to micopore or adhesive tapes, Calcaneum fracture, Subjects not willing to take part in the study Outcome measure: Numerical Pain Rating Scale Data Collection: Baseline pain intensity was noted on Numerical Pain Rating Scale in the weight bearing position (Standing). Taping was done to the calcaneum in weight bearing position (Toe Standing). Immediately post taping intensity of pain was noted on Numerical Pain Rating Scale in weight bearing position (Standing). Data was collected by the same researcher throughout the study for uniformity. Data Analysis: Analyzed using SPSS version 12 Software & Wilcoxon Signed Ranks Test was applied RESULTS: Pre taping to Post taping Score of Numerical Pain Rating Scale showed statistically significant change (p value = 0.001). Average score of pain Pre Taping on Numerical Pain rating scale was 7.86 & Post Taping was 4.06 which is clinically significant. CONCLUSION: Mulligan’s taping was found to be effective when measured immediately after taping calcaneum in weight bearing position CLINICAL SIGNIFICANCE: Mulligan’s Taping is conservative, cost effective & easy to perform which gives immediate pain relief & may hasten recovery. EMAIL: [email protected]



CAN LUMBAR SPINE DISORDER BE A CAUSE OF RESTRICTION OF RANGE IN A KNEE JOINT?.

Asha Menon

Bsc P.T., Cert. MDT OBJECTIVE: To determine if treatment to the lumbar spine can improve pain and stiffness in the knee METHODOLOGY: Study Design: Case Series The sample size was 18 patients from a population of 47 patients taken consecutively from an outpatient physiotherapy clinic. Inclusion criteria: isolated knee pain with movement loss, knee symptoms influenced by repeated movement testing of lumbar spine on first assessment. Exclusion criteria: post surgical, post trauma, medical causes for symptoms at knee, non-compliance to home programme and attrition after recovery. The average age of the patients was 45.4, 4 were male and 14 female. The average length of symptoms was 33.2 weeks with 66.6% of the patients with symptoms greater than 6 months. The average pain rating was 8.55 on VAS scale. The average knee flexion range was 88.6 deg. 83 % of patients had previously received treatment for their knee. 3 patients were off work. Functional disabilities included Indian squatting, cross leg floor sitting, walking, stair ascending and descending, kneel sitting. Outcome measures- graded as excellent, good, fair, and poor were mechanical responses at knee, rapid reversal in functional disability, symptomatic response at knee measured on 0-10 numerical scale, return to work and changes in gait. All patients were assessed using the McKenzie assessment form evidenced to reliability,(K=0.8). Repeated movement testing in spinal flexion decreased the knee range and increased knee symptoms in all patients. In 10 patients repeated extension in lying increased knee flexion range and decreased knee pain. In 8 patients the same responses were achieved with hips off center. All eighteen patients had a lumbar extension or extension with a lateral directional preference, hence classified as lumbar derangement syndrome. Treatment principles were education, lumbar spine directional preference exercises and clinician procedures to fully recover the knee range, abolish knee pain and restore to normal functions. RESULTS: All 18 patients showed an excellent outcome in an average of 4.9 treatment sessions. CONCLUSION: In these 18 patients, treatment consisting of directional preference exercises for the lumbar spine restored knee mobility and abolished knee symptoms. Clinical relevance is, if a knee assessment fails to elicit outcomes, it is appropriate to conduct a lumbar spine assessment. Further research needs to be performed to determine how treatment to the lumbar spine alters a loss of mobility in the knee. KEY WORDS: Knee joint movement loss, McKenzie Spine assessment, Mechanical Responses. EMAIL: [email protected]



EFFECT OF NERVOUS TISSUE MOBILIZATION ON HAND FUNCTION IN LEPROSY

Dr Tejashree Dabholkar, Dr Sujata Yardi

Department of Physiotherapy,Pad.Dr.D.Y.Patil University,Nerul,NaviMumbai.

PURPOSE OF THE STUDY: Leprosy patients can have involvement of hand function either due to end organ invasion by bacilli or by nerve trunk involvement. This affects sensory as well as motor hand function in leprosy. Nervous tissue mobilisation has been reported to be an effective intervention for conditions like carpal tunnel syndrome though benefits are still under research. The effect of nervous tissue mobilization in leprosy is not studied .Thus this study gives an insight of role of nervous tissue mobilization in leprosy hand. AIM: Effect of nervous tissue mobilization on hand function in leprosy OBJECTIVES:

1. Effect of nervous tissue mobilization on motor hand function in leprosy. 2. Effect of nervous tissue mobilization on sensory hand function in leprosy.

METHODOLOGY: Study design: Case – control trial Sample population- 60 leprosy patients Sampling technique- random Inclusion criteria- diagnosed cases of leprosy, type-I leprosy hand, age group -18-50 yrs Exclusion criteria- typeII type-III leprosy hand, previous history of any neuromusculoskeletal, pathology of upper extremity, psychological involvement Outcome Measures: pinch strength by using pinchmeter, grip strength using Jamar dynamometer ,tactile sensitivity using Semmes-Weinstein monofilament and pain sensitivity using pressure algometer . 60 subjects were randomly assigned into experimental (group-A), and control group(group-B),All patients were evaluated for baseline data of the above mentioned outcome measure. Intervention given three times a week for three weeks .Follow-up evaluation was done at the end of each treatment session(9 sessions) and one week after 9th session. DATA COLLECTION AND ANALYSIS: Data thus obtained was analyzed using paired t-test and unpaired t-test. RESULTS: Study revealed statistically significant improvement of pinch strength, grip strength ,tactile sensitivity and pain sensitivity in experimental group(p<0.001).Between group comparison revealed statistical significant(p<0.001) difference in all outcome measures with experimental group showing significant improvement. CONCLUSION: Nervous tissue mobilisation is effective in improving motor as well as sensory hand function in leprosy CLINICAL SIGNIFICANCE: Nervous tissue mobilization can be effective intervention in type-I leprosy hand KEYWORDS: leprosy hand, nervous tissue mobilization EMAIL:[email protected]



A COMPARISON OF TWO ACTIVE STRETCHING TECHNIQUES ON HAMSTRINGS FLEXIBILITY

Babina Rani

Swami Vivekanand National Institute of Rehabilitation Training and Research

(SVNIRTAR), Olatpur, Bairoi, Cuttack INTRODUCTION: Lack of hamstring flexibility has been reported to be one of the most important factors contributing to hamstrings injury during high-speed and high-intensity exercise. Active stretching of hamstrings has been found to be more beneficial than passive stretching after 4 weeks. PURPOSE OF THE STUDY: To compare the effects of two active stretching techniques- hold relax technique of PNF and neuromobilization as described by Butler, for improving the flexibility of hamstrings. METHODOLOGY: Study design: pre-test post test experimental design Sample population & size: 20 asymptomatic male subjects Sampling: random Inclusion criteria: age range: 20-30, limited right hamstrings flexibility (i.e. minimum of 150 loss of active knee extension measured with femur held at 900). Exclusion criteria: Subjects with h/o LBP, hip flexor tightness, any neuromuscular disease, surgery to LL or low back, or recent hamstring strain, and those with athletic background. Intervention: Hold relax technique included a 7sec passive stretch- 7sec maximal isometric contraction against resistance- 5sec relaxation, followed again by a 7sec passive stretch. Butler’s neuromobilization technique was performed with knee completely extended and femur as close to perpendicular as possible. With hip in adduction & internal rotation, and with passive neck flexion, the subject did active pumping by dorsiflexing and plantarflexing the foot 30 times for3 sets/session. Both groups received stretching for 5days/week for 4 weeks. Outcome measure: active knee extension (AKE) test measured with hip flexed to 900, using half-circle goniometer. Data Analysis: The dependant variables were analyzed using 2*2 ANOVA

RESULTS: Results showed a significant increase in hamstrings flexibility achieved with both the techniques (p= 0.000 for both neuromobilization and hold-relax). The mean gain in AKE achieved after 4 weeks was 11.700 + 4.320 with neuromobilization, and 11.800 + 3.080 with hold-relax. Both techniques were found to be significant but the comparison revealed no statistically significant difference between these two techniques. (p-value = 0.953). CONCLUSION: Both hold-relax and neuromobilization are equally effective in improving hamstrings flexibility in normal adults. CLINICAL SIGNIFICANCE: Use of active knee extension movement in neuromobilization helps to effectively tension the neural and hamstrings tissues, thus preventing any hamstrings strain resulting from abnormal neural retraction. Increased flexibility resulting from both these techniques may decrease the incidence of musculotendinous injuries, minimize and alleviate muscle soreness, & improve athletic performance. KEY WORDS: hamstrings, stretching, hold relax, neuromobilization EMAIL: [email protected]



CORRELATION OF NEURODYNAMICS RESPONSE OF POSTERIOR TIBIAL NERVE (PTN) WITH ANKLE FOOT

MECHANICS IN YOUNG ADULTS.

Dr. Prachi Sansare, Dr. Bhavana Mhatre, Dr. Aamita Mehta

P.T. School and Centre, Seth G. S.Medical College, Mumbai. INTRODUCTION and PURPOSE OF THE STUDY: Lifestyle activities like wearing high heels, sedentary activities can be responsible for altered mechanics of structures surrounding ankle foot complex such as reduced flexibility of tendoachilles. This results in restricted ranges of dorsiflexion, eversion and calcaneum weight bearing, non-weight bearing angle depending on degree of tightness thereby causing subtalar joint pronation and midfoot pronation progressively. Alteration of such mechanics in the joint could lead to abnormal stressing of the nerves around the area. Therefore, purpose of this study is to find out if this altered mechanics would affect dynamics of posterior tibial nerve (PTN). AIM: To find out correlation of neurodynamic response of posterior tibial nerve with kinematics of ankle-foot.

OBJECTIVE:

To assess neurodynamic response of posterior tibial nerve and kinematics of foot.

METHODOLGY:

• Study Design : Prospective non-interventional study

• Sample Population: 107

• Outcome measures: -Dorsiflexion, eversion range of motion, weight bearing, non-weight bearing angle of calcaneum, Hip flexion angle of neurodynamic test

• Data collection and analysis: A study was done on 125 asymptomatic healthy volunteers between the age of 18 – 25 yrs. Subjects having moderate to severe tightness of hamstrings were excluded. They were all assessed for neurodynamic response for right & left posterior tibial nerve. Only those subjects who showed normal neurogenic response (107) were included in the study. Dorsiflexion, Eversion range of motion, weight bearing, non-weight bearing angle of calcaneum were assessed with goniometer and degree of flat foot with feiss line. Data was analyzed to find out correlation between neurodynamic response of posterior tibial nerve using Karl-Pearson’s correlation test.

RESULTS: Posterior tibial nerve showed weak negative correlation with weight bearing angle of calcaneum (r*= -0.264, p value 0.010) and no correlation with dorsiflexion, eversion and non-weight bearing angle of calcaneum. CONCLUSION AND CLINICAL SIGNIFICANCE: Posterior tibial nerve showed weak negative correlation with weight bearing angle of calcaneum in healthy subjects and further study needs to be done on subjects having severe degree tightness of tendoachilles to find out if correlation exists. EMAIL:[email protected]



A COMPARATIVE STUDY OF C1 – C2 SUSTAINED NATURAL APOPHYSEAL GLIDE (SNAG) VS C1 – C2 SELF SUSTAINED

NATURAL APOPHYSEAL GLIDE IN THE MANAGEMENT OF CERVICOGENIC HEADACHE

Kalpesh Vasani

C. U. Shah Physiotherapy College, Surendranagar, Gujarat

OBJECTIVE: To Compare the Effectiveness of C1 – C2 Sustained Natural Apophyseal Glide (SNAG) Vs Self - Sustained Natural Apophyseal Glide on the Cervicogenic Headache. METHODOLOGY:

a) Study Design: Randomized, Comparative Study b) Sample population & Sample Size: A sample of 32 subjects with

cervicogenic headache and FRT limitation were randomized into a C1 - C2 SNAG or C1 – C2 self SNAG groups

c) Sampling Technique: Simple random Sampling d) Inclusion Criteria: Unilateral or side-dominant headache without side shift,

Headache with neck stiffness and/or pain, Headache for the past 3 months at least once per week, Aged 18-66 Positive flexion-rotation test and restriction greater than 10°

e) Exclusion Criteria: Headache not of cervical origin, Physiotherapy or chiropractic treatment in the past 3 months, Headache with autonomic involvement, dizziness, or visual disturbance, Congenital conditions of the cervical spine, Contraindication to manipulative therapy, Involvement in litigation or compensation, Inability to tolerate the flexion-rotation test

Outcome Measures: A Goniometer, Flexion Rotation Test, Headache Questionnaire Data Collection & Analysis: Statistical analysis was carried out using SPSS V12.0 Alpha was set at .05 for each analysis. Age, headache history, headache severity in-dex, and range of rotation in the FRT at baseline for both groups were analyzed with an independent t test. RESULT: No differences were found in baseline measures between groups. Immedi-ately after the initial instruction and practice visit performed with the supervision of the therapist, FRT range increased by 15° for the C1-C2 SNAG group (P < 001), which was significantly more than 5° for the C1-C2 self-SNAG intervention (P < 001). There was no difference in headache index scores at baseline between groups. Headache index scores were substantially less in the C1-C2 SNAG group ( at 4 weeks & 12 weeks) compared to the C1-C2 self-SNAG (at 4 wks & 12 weeks) at 4 weeks (P < 001) and 12 weeks (P < 001), with an overall (+/-SD) reduction of 54% (+/-17%) for the individuals in the C1-C2 SNAG group. CONCLUSION: Here we have done the study to compare the effectiveness between the C1 – C2 SNAG and C1 – C2 self SNAG in the treatment of cervicogenic headache and found out the more effectiveness of C1 – C2 SNAG technique then compared to the C1-C2 self SNAG technique. EMAIL: [email protected]



EFFECT OF STRUCTURED MANUAL THERAPY PROGRAM ON PATTERN OF RESTRICTED RANGE OF MOTION FOR

SUBJECTS HAVING ADHESIVE CAPSULITIS

Bhavana S. Mhatre, Sushama Gajakos, Dipti Geete, Amita Mehta

PT School & Centre, Seth GSMC & KEMH Mumbai AIM & OBJECTIVE: Defining pattern of restriction, for subjects having idiopathic pain and loss of shoulder joint motion, will help in differentiation of shoulder structures. This is essential to implement effective physiotherapy interventions. Cyriax’s proposed Capsular pattern, which is external rotation restriction more than abduction and abduction restriction more than internal rotation, is not observed in all these patients. This study therefore aims to identify the pattern of restricted range of motion and evaluate the effects of structured joint and soft tissue mobilisation implemented depending on the pattern of restricted range of motion. METHODOLOGY: Study Design : Prospective, Experimental. Sample population and size : 40 subjects of age group of 45 to 65 years referred to Physiotherapy department with a diagnosis of shoulder pain or adhesive capsulitis participated in the study. All subjects were assessed with shoulder joint assessment proforma. Outcome measure : Range of motion of Flexion , Abduction, External Rotation, Medial Rotation was measured with a Goniometer. Subjects were then divided depending on pattern of restricted ROM , in two Groups Group A --- 14 patients with External Rotation restricted more than Internal Rotation Group B --- 26 patients with Internal Rotation restricted more than External Rotation Treatment : Group A received Maitland’s anterior and inferior glide and soft tissue mobilisation to internal rotators of the shoulder joint. Group B received Maitland’s posterior and inferior glide and soft tissue mobilisation to external rotators of the shoulder joint. Both the groups received Ultrasound therapy and exercises for retraining of scapular muscles Home exercise program was strictly emphasised to both the groups Subjects were then assessed again for range of motion after 7 sessions of above mentioned treatment. Data was analysed using statistical paired t test. RESULTS: Group A : The mean of paired difference for abduction range was - 8.89 ( 8-D +/- 6.04 ) and for external rotation was -7.76 ( S.D. +/- 5.8 ) was found to be significant P < 0.05. Group B : The mean of paired difference for flexion range was - 15.19 ( S.D. +/- 10.22 ) and internal rotation range was -13.63 ( S.D. +/- 8.15 ) and was found to be highly significant ( P < 0.001 ) Conclusion: Analysis of pattern of restricted range of motion is necessary to implement cost and time effective Physiotherapy intervention . However for level 1 evidence randomised control trial has already been initiated at the institute. KEYWORDS: Shoulder ; Movement, pattern, loss; Capsulitis ; Manual Therapy. EMAIL: [email protected]



COMPARISON BETWEEN THE EFFECTS OF POST ISOMETRIC RELAXATION AND STRAIN COUNTER STRAIN IN TREATMENT OF UPPER TRAPEZIUS TRIGGER POINTS

Ashish Nagar, Dr P. Dhakshinamoorthy

SBSPGI

AIMS AND PURPOSE: The aim of the study was to compare between the effects of strain counter strain and post isometric relaxation in treatment of upper trapezius trigger points. Purpose is to find an appropriate manual therapy technique among direct (Post Isometric Relaxation) and indirect(Strain Counter Strain) techniques along with specific local interventions. METHODOLOGY: The study is experimental in design and comparative in nature.400 subjects were chosen as population of the study. A sample of 30 subjects , 15 men and 15 women, on the basis of inclusion criteria ie the patients with active upper trapezius trigger points, age group 20 to 55 yrs and VAS score of minimum 3 and exclusion criteria of cervical radiculopathy, fibromyalgia and patient taking analgesic drugs; were randomly divided into 3 groups ; group A was treated with trigger point pressure release followed by post isometric relaxation technique, group B was treated with trigger point pressure release followed by strain counter strain technique, and group C as control group. Outcome measures:The outcome measures were pressure pain threshold taken by algometer, pain score on visual analogue scale(VAS) and bilateral active cervical rotation range of motion (RR & LR) measured by goniometer. It was assessed pretreatment (0th ) session, 4th and 8th session of the 8 days of treatment. DATA ANALYSIS AND RESULT: One way Anova was done to compare mean difference of 0-4, 4-8 and 0-8 sessions between 3 groups A, B and C.Result showed significant difference at 0-8 sessions with F values 6.31,4.56,4.39,4.26 for pressure pain threshold, VAS score, right and left rotation range of motion respectively.When the groups were compared using post hoc scheffe’s test, no significant difference was found. CONCLUSION AND CLINICAL SIGNIFICANCE: It can be concluded that both group A (PIR) and group B (SCS) are equally effective in reducing pain score on VAS, increasing pressure pain threshold (PPT) and bilateral cervical rotation (RR & LR) range of motion. As it would provide the physiotherapist with a simple, cost effective, non-invasive and time saving treatment method for treatment of upper trapezius trigger points. KEYWORDS: Trigger point, post isometric relaxation, strain counter strain

EMAIL: [email protected]



EFFICACY OF MUSCLE ENERGY TECHNIQUE IN THE MANAGEMENT OF SHOULDER PAIN WITH PECTORALIS

MINOR TIGHTNESS: A RANDOMIZED CONTROLLED TRIAL.

Umasankar Mohanty, Uttam Kumar Tiwary, Vishal Goel

MTFI Manual Therapy and Pain Clinic, Mangalore Health Care Centre, Car Street, Mangalore.

AIM AND OBJECTIVE AND PURPOSE OF STUDY: Postural abnormality and muscle imbalance are thought to contribute to pain and a loss of normal function in the upper body. A shortened pectoralis minor muscle is commonly identified as part of this imbalance. The muscle tightness leads to shoulder pain for many subjects. The aim of this study was to determine the efficacy of muscle energy technique on range of motion, reported pain and reported function in patients with shoulder pain due to pectoralis minor tightness. METHODOLOGY: a.Study Design: A randomized controlled trial. b.Sample Population and Sample Size: Total 60 subjects were selected for the study. c.Sampling Technique: The subjects were randomly divided to two groups 1. Experimental( n=30) group 2. Control ( n=30) group. d.Inclusion Criteria: Subjects having pectoralis minor tightness with shoulder pain. At least three months of complaints Ability to complete questionnaires in English Exclusion Criteria: Acute fractures, malignancies in the shoulder region, Rheumatoid arthritis, osteoarthritis, damage of the glenohumeral cartilage, Hill-Sachs lesion, osteoporosis, Neurological deficits affecting shoulder function in activities of daily living, Pain and/or disorders of the cervical spine, elbow, wrist and/or hand e. Outcome Measures collection and analysis: The outcome measures used were Shoulder Pain and Disability Index(SPADI), Flexilevel Scale of Shoulder Function (FLEX-SF) and Functional Assessment for the Shoulder of Constant and Murley. The data analysis was done by one way ANOVA. RESULTS: The results should significant difference between the experimental group and control group for SPADI (p=.034), FLEX-SF ( p=.022) and Functional Assessment for the Shoulder of Constant and Murley(p=.030). CONCLUSION AND CLINICAL SIGNIFICANCE: The findings of this study showed that the outcome of the experimental group was statistically highly significant. Once the length of the tight pectoralis minor is restored using the muscle energy techniques the shoulder pain reduces. KEYWORDS: Shoulder pain, Pectoralis Minor, Muscle Energy Technique EMAIL: [email protected]



A RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE EFFICACY OF MOBILIZATION WITH LUMBAR EXTENSION EXERCISE FOR THE TREATMENT OF POSTERIOR LUMBAR

DISC PROLAPSE.

Vishal Goel, Uttam Kumar Tiwary, Umasankar Mohanty.

MTFI Manual Therapy and Pain Clinic, Mangalore Health Care Center, Car Street, Mangalore.

AIM AND OBJECTIVE AND PURPOSE OF STUDY: Among all the causes of chronic low back pain, lumbar disc prolapse is one of the most frequent sources of pain. The purpose of this study was to evaluate the efficacy of mobilization with lumbar extension exercises in relieving pain in patients experiencing mechanical low back pain due to disc prolapse. METHODOLOGY: a.Study Design: This was a randomized controlled trial. b.Sample Population and Sample Size: 40 patients with chronic low back pain with disc involvement of more than 2 weeks duration. c.Sampling Technique: The subjects were randomly divided to two groups 1. Experimental( n=20) group 2. Control ( n=20) group. The experimental group patients received mobilization with lumbar extension exercises. The control group received only exercise. d.Inclusion Criteria: Subjects having low back pain with disc involvement Ability to complete questionnaires in English Exclusion Criteria: Acute fractures, malignancies in the lumbar region, Rheumatoid arthritis, Neurological deficits affecting lower limb function in activities of daily living. e. Outcome Measures collection and analysis: The outcome measures used were Aberdeen Low Back Pain Scale and Low Back Pain Disability Questionnaire of Roland and Morris .The data analysis was done by one way ANOVA. RESULTS: The results showed significant difference between the experimental group and control group for Aberdeen Low Back Pain Scale (p=.0112) and Low Back Pain Disability Questionnaire of Roland and Morris (p=.026). CONCLUSION AND CLINICAL SIGNIFICANCE: The findings of this study suggested that the outcome of the experimental group was statistically highly significant. Mobilisation with lumbar extension exercise showed significant pain relief for lumbar disc prolapse. KEYWORDS: Disc Prolapse, Mobilisation, Extension Exercise. EMAIL: [email protected]



A RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE EFFICACY OF MOBILIZATION WITH TAPING FOR THE

TREATMENT OF LUMBAR FACET DYSFUNCTIONS.

Uttam Kumar Tiwary, Umasankar Mohanty, Vishal Goel.

MTFI Manual Therapy and Pain Clinic, Mangalore Health Care Center, Car Street, Mangalore.

AIM AND OBJECTIVE AND PURPOSE OF STUDY: Among all the causes of chronic low back pain, lumbar facet dysfunction is one of the most frequent, yet under considered sources of pain. The purpose of this prospective, randomized controlled trial was to evaluate the efficacy of mobilization with taping in relieving pain in patients experiencing mechanical low back pain due to lumbar facet dysfunction. METHODOLOGY: a.Study Design: This was a randomized controlled trial. b.Sample Population and Sample Size: 40 patients with chronic low back pain of more than 2 weeks duration. c.Sampling Technique: The subjects were randomly divided to two groups 1. Experimental( n=20) group 2. Control ( n=20) group. The experimental group patients received mobilization with taping. The control group received only table top exercise. d.Inclusion Criteria: Subjects having low back pain with facetal involvement At least two weeks of complaints Ability to complete questionnaires in English Exclusion Criteria: Acute fractures, malignancies in the lumbar region, Rheumatoid arthritis, Neurological deficits affecting lower limb function in activities of daily living. e. Outcome Measures collection and analysis: The outcome measures used were Aberdeen Low Back Pain Scale and Low Back Pain Disability Questionnaire of Roland and Morris .The data analysis was done by one way ANOVA. RESULTS: The results showed significant difference between the experimental group and control group for Aberdeen Low Back Pain Scale (p=.0142) and Low Back Pain Disability Questionnaire of Roland and Morris (p=.036). CONCLUSION AND CLINICAL SIGNIFICANCE: The findings of this study suggested that the outcome of the experimental group was statistically highly significant. Mobilisation with Taping showed significant pain relief for lumbar facet dysfunction. KEYWORDS: Facet Syndrome, Mobilisation, Taping Technique. EMAIL: [email protected]



COMPARISON BETWEEN EFFECTIVENESS OF MYOFASCIAL RELEASE VERSUS MUSCLE ENERGY TECHNIQUE IN

RELIEVING PAIN IN UPPER TRAPEZIUS MUSCLE DUE TO SPASM IN POST OPERATIVE OPEN HEART SURGERY PATIENTS.

Tejal Narkhede, Prarthana Dhotre, Dr. Mrs. Raziya Nagarwala


AIMS: To study the effectiveness of muscle energy technique vs. myofascial release in upper trapezius muscle spasm in post open heart surgery patients. OBJECTIVES:

1. To study the effectiveness of muscle energy technique on upper trapezius muscle spasm in post open heart surgery patients.

2. To study the effectiveness of myofascial release on upper trapezius muscle spasm in post open heart surgery patients.

3. To compare the effectiveness of the muscle energy technique and myofascial release. METHODOLOGY/ INTERVENTION: Study design: Experimental study Sample population: Open heart surgery patients post op day 1 Sample size: 16 Muscle energy technique: n=9 Myofascial release: n=7 Sampling technique: Simple Random Sampling Inclusion criteria: 1. Post operative day1 patients undergone open heart surgery with . midsternotomy approach with upper trapezius muscle spasm 2. Pain on visual analogue scale of 5 and above. 3. Cognitive (able to understand Visual Analogue Scale) Exclusion criterion: 1.Heamodynamically unstable patients 2. History of previous trauma to the cervical spine. 3. Inflammatory disorders such as Rheumatoid arthritis. Data collection: 16 patients were randomized to either of the experimental group. All the patients were give scapular retraction, chin tucks, and shoulder rolls and serratus anterior activation as the basic treatment. Patients marked their pain on the visual analogue scale before and after each treatment. Three day follow up was done. Data Analysis: SPSS software was used 1. Wilcoxon’s test was used to correlate pre and post changes in pain on VAS Scale. 2. Mannwhitney’s test was used to compare the changes in the pain levels between both groups. RESULTS: There was statistically significant difference in the pain levels in muscle energy technique with p=0.005 for day1, p=0.007 for day2, p=0.007 for day3. There was statistically significant difference in the pain levels in myofascial release group with p=0.018 for day1, p=0.017 for day2, p=0.018 for day3. There was no statistically significant in the pain levels between the two groups p=0.016 for day1, p=0.074 for day2 and p=0,106 for day3. CONCLUSION: Both techniques are equally effective in reducing pain due to upper trapezius muscle spasm in post operative open heart surgery patients. KEYWORDS: Myofascial release technique, Muscle Energy Technique, Upper Trapezius Muscle Spasm. EMAIL: [email protected]



INCIDENCE OF CERVICO-THORACIC DYSFUNCTIONS IN PATIENTS WITH LOW BACK PAIN AND EFFECTS OF

MANUAL THERAPY APPROACHES IN THE MANAGEMENT LUMBAR PIVD – AN INNOVATIVE APPROACH

P.P.Mohanty, Monalisa Pattnaik, Arkesh Pattnaik

Swami Vivekananda National Institute of Rehabilitation Training & Research,

Olatpur,Bairoi, Cuttack-754010 INTRODUCTION: Many causes exist for low back pain but there is paucity of research in upper quadrant involvement in LBP PURPOSE: To find the incidence of cervico-thoracic dysfunction in LBP and effect of 3 manual therapy protocols in the management of lumbar PIVD. METHODOLOGY: Design: Experimental Sample: 520 subjects (M- 232, F- 288, age range: 35-55) with low back pain with or without radiation were screened. 430 subjects had associated cervico-thoracic dysfunction (M- 180, F- 250) (166 spondylosis, 61 spondylolisthesis, 43 PIVD and 160 non –specific LBP). 30 subjects (M- 22, F- 08) with PIVD meeting the inclusion & exclusion criteria were recruited randomly. Inclusion criteria: Radiating pain to unilateral lower limb, loss of lumbar lordosis & lateral deviation, painful restriction of movement towards painful side and SLR. Exclusion Criteria: Contra – indications to manual therapy and painful shoulder. Outcome Measures: Pain (VAS) and Oswestry low back pain disability questionnaire Procedure: All patients were evaluated for Central PA pressure of cervicothoracic spines and myofascial pain syndrome in periscapular muscles by digital algometer that reproduce the original symptoms. After the subjects had fulfilled the criteria and signed the informed consent, subjects were assigned to one of the 3 groups and assessed for dependant variables. The following treatment were administered Group I ( McKenzie) ,Group II (Cyriax), Group III [integrated approach (Cyriax’s listing correction, myofascial release, central PA mobilization of Cervicothoracic spine & McKenzie’s extension exercises)]. After 3 weeks of treatment (5 days a week, one session per day) post measurement readings were taken. Data Analysis: Data were analysed using 3X2 ANOVA with one between factor and one within factor. All pair wise, post hoc was calculated at 0.05 level of significance. RESULTS: 82.73 % of patients with low back pain had associated cervicothoracic dysfunctions and myofascial pain syndrome in levator scapulae and/or rhomboids. Oswestry disability questionnaire- main effect for time (F=1, 27,0.05)F = 989.048, p=0.00 and group (F= 2,27, 0.05) F = 2.565, and group x time interaction (F= 2, 27, 0.05 ) F = 7.597, p=0.02 . Pain - main effect for time (F=1, 27, .05) F = 419.904, p=0.00 and time x group (F=2, 27, 0.05) F = 9.828, p=0.02. Tukey’s post hoc shows Group III was better in improving both pain and Oswestry disability questionnaire. CONCLUSION & CLINICAL SIGNIFICANCE: low back pain with or without radiation should be screened for cervicothoracic dysfunctions and myofascial pain in levator scapulae and/or rhomboids. An integrated approach to manual therapy is effective in the management of PIVD. KEYWORDS: Mobilisation, cervico-thoracic dysfunctions, myofascial pain syndrome, lumbar prolapsed intervertebral disc EMAIL: [email protected]



MECHANICAL NECK PAIN – A COMPARISON BETWEEN TWO MANUAL THERAPY APPROACHES.

G. Shankar Ganesh, Mr.P.P.Mohanty

Swami Vivekananda National Institute of Rehabilitation Training and Research

(SVNIRTAR), Cuttack – 754010, Orissa. INTRODUCTION: Mechanical neck pain is characterized by restriction of range of motion and functional limitations and is an important socioeconomic burden to society, affecting 10% to 20% of the population at any given time. Clinical practice guidelines recommend the use of manual therapy for managing mechanical neck disorders. PURPOSE OF THE STUDY: To compare the effectiveness of Maitland mobilization and Mulligan’s mobilization along with exercises on pain, range of motion and functional ability in subjects with mechanical neck pain. METHODOLOGY: Design: Experimental. Double Blind study. Sample: 30 subjects (19 males and 11 females) were recruited from the outpatient department of SVNIRTAR. Sampling: Random Inclusion criteria: Subjects in 21 – 45 years of age, complaints of insidious onset of pain that has lasted for less than 12 weeks and reduced range of motion in extension, side flexion and rotation to one or both sides. Exclusion Criteria: Contr indications to manual therapy, Radiation to the upper limb. Outcome Measures: Pain (Visual Analog Scale),Range of motion (180 degree goniometer) and Neck Disability index PROCEDURE: After the subjects had fulfilled the criteria and signed the informed consent, subjects were randomly assigned to one of the 2 groups and assessed for dependant variables by an examiner blinded to group allocation. Post measurement readings were taken after 2 weeks of therapy. The results of the same were not revealed to the principal researcher. Group I received Maitland (Central and Unilateral PA) and strengthening exercises. Group II received Mulligan SNAGS and strengthening exercises. Both groups received therapy intervention for a period of 2 weeks. (5 days a week, one session per day). Data analysis: The dependant variables were analyzed using repeated measures ANOVA. There was one between factor with two levels, and one within factor. All pair wise, post –hoc comparisons was done using a .05 level of significance. RESULTS: Repeated ANOVA tests yielded no statistically significant results in ROM (Extension, side flexion to left, side flexion to right, rotation to left, rotation to right)(P=0.201, P=0.389, P=0.226, P=0.984, P=0.727 respectively),pain (P=0.494) & NDI (P=0.151) between groups. However, significant within group differences were observed in ROM, pain & NDI (P=0.00) CONCLUSION AND CLINICAL SIGNIFICANCE: Mulligan mobilization is as effective as Maitland mobilization in reducing pain, improving ROM and disability, when combined with exercise. Multimodal approach including manual therapy and exercise is a potentially useful intervention in the management of mechanical neck disorders. KEYWORDS: Mechanical neck pain, Maitland, Mulligan, Exercises EMAIL: [email protected]


MANUAL THERAPY SECTION

DIGITAL PAPERS



FACTORS RELATED TO THE INABILITY OF INDIVIDUALS WITH LOW BACK PAIN TO IMPROVE WITH A SPINAL MANIPULATION

Amit Murli Patel

JG College of Physiotherapy, JG Campus of Excellence, Opp. Gulab Tower, Off. Sola Road,

Ahmedabad -380061, Gujarat. AIMS, OBJECTIVE & PURPOSE OF THE STUDY: Although Spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation. METHODOLOGY: Study Design: This study involved a prospective cohort of patients with Low Back Pain recruited from 2 outpatient facilities: Shivam Orthopaedic hospital & Aarohi Orthopaedic hospital. 75 patients with nonradicular low back pain (mean age=37.6 years, SD=10.6, Range=19–59; mean duration of symptoms=41.7 days, SD=54.7, range=1–252) participated. Sample Population: 32 Male patients & 43 Female patients. Sample Size: 75 subjects participated in this study, and 71 (95%) completed the intervention protocol. 4 subjects dropped out. Data from these 4 subjects were not included in the analysis. Sampling Method: Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; lumbar and hip range of motion (ROM). All subjects received spinal manipulation for a maximum of 2 sessions. Subjects not showing more than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have no improvement. Baseline variables were tested for univariate relationship with outcome of manipulation. Variables showing univariate relationship were entered into a logistic regression equation, adjusted odds ratios were calculated. Inclusion Criteria: Age between 18 and 60 years; referral for physical therapy with a diagnosis related to the lumbosacral spine; a chief complaint of pain or numbness in the lumbar spine, buttock, and/or lower extremity; and a baseline Modified Oswestry Low Back Pain Disability Questionnaire (OSW) score of at least 30%. Exclusion Criteria: current pregnancy, signs consistent with nerve root compression, prior lumbar spine surgery, history of osteoporosis or spinal fracture. Outcome measures: Few physical examination findings were associated with manipulation outcome. Most of the examination variables associated with treatment failure were related to hip rotation ROM. We found that subjects who did not improve with manipulation had less Medial Rotation and Lateral Rotation. Subjects who did not improve had less discrepancy in Medial Rotation between the left and right hips and had less total rotation. Data Analytical Test: Pearson chi-square tests were used for nominal and ordinal baseline variables, and independent sample t tests were used for continuous baseline variables. RESULTS: Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation ROM, and a negative Gaenslen sign. The 6 variables were entered into a logistic regression model. The final model fits the data; X2 = 4.87, P= 0.77. The Nagelkerke R2 value for the final model was 0.63, indicating that the 6 variables explained 63% of the variance in manipulation outcome. CONCLUSION & CLINICAL SIGNIFICANCE: The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve. KEYWORDS:- Evidence Based practice, low back pain, Spinal manipulation. EMAIL: [email protected]



EFFECT OF MULLIGAN’S MOBILISATION OVER ROUTINE PHYSIOTHERAPY IN TREATMENT OF PATIENTS

DIAGNOSED AS FROZEN SHOULDER

Aditya Dandekar, Dr G. J. Ramteke

Ravi Nair Physiotherapy College, Sawangi Meghe, Wardha AIM: To study the effect of mulligan’s mobilization over routine physiotherapy treatment in patients diagnosed as frozen shoulder. OBJECTIVES- 1. To create awareness about physiotherapy treatment for frozen shoulder. 2. To teach self treatment mode for treatment in patient diagnosed as frozen shoulder. 3. To find out the effect of mulligan’s mobilization in patients diagnosed as frozen shoulder. PURPOSE OF THE STUDY- No study has been conducted on effect of mulligan’s shoulder joint mobilization so in order to identify effect of mulligan’s mobilization in frozen shoulder and also encourage use of mulligan’s mobilization in routine physiotherapy treatment. METHODOLOGY- Study design- Comparative study. Sample size- minimum of 20 subjects Sample technique- Purposive sampling Inclusion Criteria – Both genders, Patients diagnosed as frozen shoulder with age 30-70 years. Exclusion criteria-Post traumatic shoulder joint condition or pathologies, Shoulder joint rheumatoid arthritis, Patient undergone corticosteroid injection therapy, Malignant shoulder joint conditions, Neurological conditions. Outcome measure- 1. Primary outcome measure was numerical pain rating scale on patient reported status of pain. 2. Secondary outcome measure was oxford shoulder score for examination of improvement in functional activities. Data analysis- Data was collected according to assessment proforma and were analyzed using various statistical measures such as mean, standard deviation and test of significance such as unpaired ‘t’ test and Mann Whitney test were utilized. RESULT- Result of present study showed that the Mulligan’s mobilization with Mulligan’s self mobilization exercises were superior than routine physiotherapy treatment only in treatment of frozen shoulder in terms of increasing range of motion(Goniometry), decrease in pain(Numerical pain rating scale), improvement in functional activities (Oxford shoulder score). CONCLUSION- Purposive sampling study found that the Mulligan’s mobilization with Mulligan’s self mobilization exercises were effective in treatment of frozen shoulder and hence clinically can used in treatment of frozen shoulder and other shoulder joint conditions/ pathologies. KEYWORDS- Mulligan’s, mobilization, frozen, shoulder, frozen shoulder. EMAIL- [email protected]



PHYSIOTHERAPY (PT) MANAGEMENT OF CUBITAL TUNNEL SYNDROME AFTER RECONSTRUCTION OF MEDIAL

COLLATERAL LIGAMENT (MCL) OF THE ELBOW

Dr.Priya Malgundkar 1, Dr. Bhavana Mhatre 2

1: Ramakrishna Mission Hospital, Mumbai 2: Seth G.S. Medical College and KEM Hospital, Mumbai

INTRODUCTION: Ulnar nerve injury at the elbow results from repetitive traction combined with elbow ligament laxity, recurrent subluxation of nerve outside the ulnar groove. Insufficiency/laxity of anterior bundle of MCL commonly stresses the ulnar nerve in the cubital tunnel. Surgical transposition of ulnar nerve may eventually be required for the alleviation of symptoms. PURPOSE: The purpose of this case study was to study the effects of PT treatment of cubital tunnel syndrome (CTS) developed after MCL reconstruction at the elbow. STUDY DESIGN: Single case study SUBJECT: Subject was a 22 yr old male, chef by occupation and a club level football player. Subject had undergone an MCL reconstruction of the elbow with a palmaris longus graft without transposition of the ulnar nerve. METHOD: PT treatment was started post operative 6 months. PT assessment was done, 10 RM of the subject was calculated and strengthening program as per protocol was prescribed. Subject was able to lift 4 kg for the biceps by 3 months. After 3 months of training, subject complained of tingling and pain over the posterior medial aspect of the elbow with occasional clicks.

PT examination revealed: swelling and tenderness over the ulnar nerve, 25% hypoesthesia over the ulnar nerve distribution, Tinels sign +ve at the elbow, Ulnar nerve NDT +ve, repeated subluxation of the nerve out of the groove during extension.

The patient was diagnosed as CTS and referred to the operating surgeon who advised a nerve transposition. Subject refused to undergo a second surgery and consented for PT intervention. The elbow weights were reduced and the FCU muscle was strengthened along with a medial ulnar glide to provide valgus stability. Later, Shacklock’s ulnar sliding mobilization technique was started for mobilization of the ulnar nerve in the groove. RESULTS: The patients symptoms resolved in 2 months

• no swelling/ tenderness/subluxation of the nerve

• normal sensation over the ulnar nerve distribution

• Tinel’s sign-ve

• UNNDT normal DISCUSSION: Strengthening the FCU provided additional valgus stability to the elbow. The ulnar gliding mobilization technique also helped the sliding motion of the nerve during elbow flexion and extension movements. These helped relieve the symptoms. CONCLUSION: Symptoms of CTS can be alleviated with appropriate strengthening and neurodynamic techniques. KEYWORDS: MCL lig reconstruction, Cubital Tunnel Syndrome, Neurodynamics EMAIL: [email protected]



EFFECT OF ORTHOPEDIC MANUAL PHYSICAL THERAPY FOR ENTRAPMENT OF SUPERFICIAL PERONEAL NERVE: A

CASE REPORT

A.Sudarshan ¹, P. Antony Leo Aseer ²

1: Physiotherapist, National Sports Medicine Centre, Chennai 2: Reader, Faculty of Physiotherapy, Sri Ramachandra University

AIM AND OBJECTIVE: In most studies, treatment for the entrapment of superficial peroneal nerve has been surgical decompression by splitting of crural fascia (Styf et.al 1986) with successful outcomes. This is the first case study to report physical therapy management on the same. CASE DESCRIPTION: A 40 year old male, sales executive by profession presented with complaints of difficulty in driving a car due to pulling intermittent pain whose onset was gradual in the lower one third of the lateral aspect of fibula extending up to the second and third toe for past 6 months. Tenderness was elicited 9.7 centimeters above the lateral malleoli with positive tinel’s sign at the same site causing radiating pain. Pain was present on passive plantar flexion with inversion and on resistance to dorsiflexion with eversion. Differential diagnostic criteria excluded were stress fractures, shin splints, deep venous insufficiency, popliteal artery entrapment syndrome and spinal nerve root compression. The physical diagnosis for entrapment of superficial peroneal nerve was primarily based on provocation tests suggested by Styff et.al, 1997. Intervention consisted of hot pack followed by orthopedic manual massage (including myofascial release, deep longitudinal stripping and friction) along with neural mobilization techniques for peroneal nerve aiming to encourage motion within the interface. Lower extremity functional scale and Visual analog scale were used as an outcome measure. RESULTS: After the first treatment session, patient noted changes in pain intensity that exceeded minimal clinically important difference (from 6.3cm to 4.5cm in VAS). The minimal detectable change in Lower extremity functional scale was obtained after the third session (from 65 points in first session to 76 points) with a 100% maximal function by the fourth session. After complete resolution of pain by the sixth session, a review was done once a week for a month and a follow-up three months after the review revealed that patient was pain free. CONCLUSION: Though the treatment was purely based on a working hypothesis, one possible mechanical reason for the improved outcome could be a reduction in the tension of the crural fascia where the superficial peroneal nerve exits with improved mobility in relation to its surrounding structure. It was inferred from this case that physical therapy using manual massage and neural mobilization can be considered before surgery and it suggests the entrapment of superficial peroneal nerve as a differential diagnostic criteria. KEYWORDS: Superficial peroneal nerve, Entrapment EMAIL: [email protected]



COMPARISION OF EFFICACY OF MUSCLE ENERGY TECHNIQUE AND PASSIVE STRETCHING ON HAMSTRING

TIGHTNESS.

Kirit Prajapati, Jashree Sutharia, Yagna Shukla, Anjali Bhise

Govt. Physiotherapy College, Civil Hospital, Ahmedabad. AIM, OBJECTIVE AND PURPOSE OF STUDY: The Purpose of study to compare effectiveness of Muscle Energy Technique (MET) and Passive stretching on Hamstring Tightness. METHODOLOGY: Study design: Experimental comparative study. Sample size: 39 subjects. Sample techniques: Randomized Control Trial. Inclusive criteria: 18-25 Years normal individual, having hamstring tightness more than 15˚ were selected. Exclusive criteria: Acute/Chronic law back pain, any history of hip/knee pathology, visible acute swelling in region of hamstring muscle. Outcome measure: outcome was measured in term of Active knee extension test. Data collection and Data Analysis: 39 normal healthy subjects with hamstring were randomly allocated to two Group. Group A (n=20) Subjects were treated with muscle energy technique in which 20% of patient’s strength isometric contraction for 7-10sec followed by 5 sec rest followed by 30 sec stretching and Group B (n=19) Subjects were treated with 30 seconds passive stretching . The treatment was given for 4 repetitions in each group thrice a week for 1week. Pretest and posttest measurement were taken by Active Knee extension test. Data analysis was done by independent t-test for comparison between two Groups. RESULTS: A significant increased hamstring extensibility was achieved by both techniques per week. The mean gain of hamstrings extensibility achieved after a week itself was 11.8±4.47 with MET & 5.7±2.95 with passive stretching. On comparing group A & B the result showed significant improvement in ROM between both groups at 5% level of significance. CONCLUSION: As above result both techniques are effective to improve hamstring extensibility but MET is more effective than passive stretching. KEYWORDS: Muscle Energy Technique (MET), passive stretching, Active knee extension Test, Hamstring tightness. EMAIL: [email protected]



EFFECT OF CERVICOTHORACIC MOBILIZATION IN DISTAL RADIUS FRACTURES AFTER PLASTER REMOVAL

Jaya Arora, Dr Monalisa Pattnaik, Dr P.P.Mohanty

Swami Vivekanand national institute of Rehabilitation Training and Research

(SVNIRTAR), Olatpur, Bairoi, Cuttack INTRODUCTION: Distal Radius Fracture is common fracture in forearm. Immobilization is a contributing factor in sympathetic dysfunction. Sympatho-inhibition is a feature of acute Complex Regional Pain Syndrome. Spinal mobilization has generalized sympathoexcitatory and hypoalgesic effects. PURPOSE: To see the effect of cervicothoracic mobilisation on pain, swelling and function over conventional therapy or control in these patients after plaster removal. Design: Experimental randomized controlled study METHODOLOGY: 30 subjects (Age 35 to 60 years), conservatively managed distal radius fractures were randomly divided into 3 groups with 10 subjects each.

• Experimental central PA mobilization of C7 to T3 spine and conventional therapy

• Conventional - Conventional therapy -contrast bath and exercises. • Control- home exercise only in the second week.

Treatment was given daily 5 days a week for 2 weeks. Outcomes: Grip strength using dynamometer, swelling using volumeter, patient rated wrist evaluation scale, wrist ROM using goniometer Heart rate was monitored during intervention to see the sympathetic changes in the experimental group. Data collection: Measurements were taken prior to beginning of treatment (Pretest) , were repeated after completion of first week (Post 1) and second week (Post 2) Data analysis: Dependent variables were analysed using 3 X 3 ANOVA with repeated measures of the second factor. There was one between factor (Group) with three levels (experimental, conventional, control) , one within factor (Time) with three levels (pre, post1, post2). Pairwise post hoc comparisons were done using a 0.05 level of significance. RESULTS: Experimental group improved significantly with time in all variables at end of 1st week and 2nd week. Conventional group improved significantly with time in Patient Rated Wrist Evaluation and flexion range of motion from baseline to end of 1st week & 2nd week. However strength and extension range in this group improved only at end of 1st week. Control group showed no change. At end of 1st week & 2nd week both experimental and conventional groups showed significantly better improvements in all the variables than control group. Experimental group was better than conventional group in all variables. Flexion improved to similar extent in both the groups. CONCLUSION: This study shows that conventional physiotherapy has role in the rehabilitation of patients with distal radius fracture after plaster removal in reducing swelling, pain and improving range of motion, strength and earlier return of function. However cervicothoracic mobilisation has additional effects in all above mentioned variables. KEYWORDS: distal radius fracture, conventional treatment, cervicothoracic mobilization EMAIL: [email protected]



EFFECTS OF A PHYSIOTHERAPY PROTOCOL IN PATIENTS WITH THORACOLUMBAR DYSFUNCTION

Arkesh Patnaik, Dr P.P.Mohanty, Dr Monalisa Pattnaik

Swami Vivekanand national institute of Rehabilitation Training and Research

(SVNIRTAR), Olatpur, Bairoi, Cuttack INTRODUCTION: Back pain is a primary reason to seek medical advice; it is second only to upper respiratory infections as reasons for physician consultations. Robert Maigne described thoraco-lumbar dysfunction (TLD) as pain originating in thoraco-lumbar region, but reported by patients in either the low back or upper buttocks. These pains are mostly chronic in nature and constitute 30% of all low back pains. PURPOSE: The purpose of the study is to see the effects of lumbo-pelvic stabilization exercises and mobilization in reducing pain and improving mobility in low back pain patients with thoracolumbar dysfunction. Research design: Experimental study Sample size: 30 subjects METHODOLOGY: Subjects reporting to physiotherapy department of SVNIRTAR with complaint of low back pain were clinically assessed for signs of Thoracolumbar Dysfunction. All subjects were informed of procedures and an informed consent was obtained. Thirty patients aged 35 to 55 years fulfilling the inclusion criteria were recruited into the study and then allocated to: GROUP A (Experimental group) - 15 subjects- Posteroanterior spinal mobilisation T8 to L2, core stabilisation exercises, latissmus dorsi strengthening with theraband GROUP B (Control group) - 15 subjects- stretching exercises, hot pack at home Before initiating treatment, baseline values of all the dependent variables were taken. Variables: Independent: spinal mobilization, core stabilization exercise, latissimus dorsi strengthening exercises Dependent: Pain by VAS, Function by Oswestry low back pain disability score, spinal flexion range by modified schobers method Data Analysis: The dependent variables were analysed using 2 X 2 ANOVA with repeated measures of the second factor. There was one between factor (Group) with two levels (Experimental and control group) and one within factor (time) with two levels (pre, post). All pairwise post hoc comparisions were done using a 0.05 level of significance. RESULTS: The results of the study suggest that mobilisation of the thoracolumbar junction, core stabilisation exercises and concentric strengthening of Latismus dorsi muscle has a beneficial effect in patients with low back pain due to thoracolumbar dysfunction. There was statistically significant reduction in pain and improvement in function and flexion range of motion over time in the experimental group . CONCLUSION: Patients with low back pain with or without radiation to lower limbs having signs of thoracolumbar dysfunction when treated with thoracolumbar central PA mobilisation, concentric strengthening of latissmus dorsi and core stabilisation exercises show reduction of pain and improvement in function and flexibility. Keywords: thoracolumbar dysfunction, spinal mobilisation, core stabilisation EMAIL: [email protected]


INNOVATIVE PAPER SECTION


ABSTRACT NO 176 (INNOVATIVE 1)

PHYSIOLOGICAL VARIATIONS AND TENDENCY OF ACUTE MOUNTAIN SICKNESS FOR OCCASIONAL MOUNTAIN

TREKKERS.

Dr.Umasankar Mohanty 1, Dr.H.Nagalingappa2

1: Chief Consultant Therapist,Mangalore Healthcare Centre, Car Street, Mangalore 2: Chairman and Director of Physical Education and Sports, Mangalore University

AIM AND OBJECTIVE AND PURPOSE OF STUDY: Few sights are more breathtaking and Inspirational than a mountain peak. The number of people traveling for mountain trekking has risen enormously. Without special climbing ability these climbers are exposed to the altitudes they are not used to in their usual lifestyle. The purpose of the study was to find out the physiological variations ( Blood Pressure, Pulse rate and O2 saturation) for the mountain climbers and the tendency of Acute Mountain Sickness for the mountain climbers. METHODOLOGY: a.Study Design: A Cross-sectional study. b.Sample Population and Sample Size: The study was conducted for 350 mountain climbers between January,2007 till September,2010. The average age group was 21.41 ± .72 year. 180 males and 170 females participated in the research study. c.Sampling Technique: The research study was conducted at a popular trekking spot Doddaribetta,Charmadi Ghats( 4,300 ft above sea level). In the study the physiological parameters were measured prior to trekking and while trekking. d.Inclusion Criteria: Subjects physically fit, Ability to complete questionnaires in English Exclusion Criteria: History of cardiac problems, Respiratory problems and Diabetes. e. Outcome Measures collection and analysis: The measured parameters were Systolic Blood pressure, Diastolic Blood Pressure, Pulse rate and Oxygen saturation. Immediately after the trekking was over a questionnaire named Lake Louise AMS Questionnaire was given to check for acute mountain sickness. The questionnaire measures for Headache, Gastro Intestinal Problems, Fatigue/weak, Dizzy/lightheaded, Difficulty sleeping, Change in mental status, Ataxia(heel to toe walking) and Peripheral edema. RESULTS: The physiological variations were checked by paired-T test. For the Systolic blood pressure (p<.001) Diastolic blood pressure (P<.001) and Pulse Rate (P<.001) were found to be increased significantly. The O2 Saturation was found to be decreased significantly (P<.046). In the AMS score 136 trekkers had no complains, 133 complained of ataxia and 36 complained of Headache. CONCLUSIONS: In the study we found that trekking is associated with increased B.P, Pulse rate and decrease in Oxygen level. Seeing the parameters we recommend that precaution must be taken by individuals with High B.P, Diabetics and Heart ailments and people with sedentary life style. KEY WORDS: High Altitude, Mountain Trekkers, Acute Mountain Sickness. E-MAIL: [email protected]



ANALYSIS OF CHANGES OF KINEMATICS OF HIP, KNEE AND ANKLE IN JUMP KNEE & CROUCH TYPE OF GAIT IN CHILDREN

WITH CEREBRAL PALSY USING CINEMATOGRAPHIC MEASUREMENTS WITH DIGITAL GONIOMETRY

Dr. Gajanan Bhalerao (PT) 1, Ms. Purvi Raisoni1, Ms. Saloni Raje 1,

Dr. Mrs. Shaila Sabnis (PT) 1, Dr. Vivek Kulkarni (PT) 1, Dr. Mrs. Vasanti Joshi (PT) 1, Dr. Shweta Gore (PT) 1, Dr. Asha Chitnis (PT) 2

1: Sancheti Institute College of Physiotherapy, Shivaji Nagar, Pune-411005

2: Paediatric Clinic, Dadar, Mumbai INTRODUCTION: -Cerebral Palsy results from static injury to the developing brain. This type of injury to the CNS commonly results in abnormal motor control associated with a delay in onset of walking and further into an abnormal gait pattern. Therefore, gait analysis is important to quantify human locomotion in Cerebral Palsy and to provide detailed data on components of gait and factors affecting abnormal gait to help in the decision making process. 3D gait analysis system have been shown to give reliable and valid measurements, but it is costly and may be impractical to use as everyday assessment tool. So comparatively 2D gait analysis is reasonably feasible, less expensive & easy clinical tool of gait assessment. AIM: -

1. To find the changes of kinematics of hip, knee and ankle in different phases of gait cycle in jump knee and crouch type of gait.

2. To Correlate abnormalities physical findings with changes in kinematics of gait cycle. METHOD :- Study Design: - Descriptive analysis, Sample size: - 8 (7 males & 1 females) Inclusion Criteria:- 1. Spastic diplegia cerebral palsy. 2. GMFCS level I and II. Materials: Sony Handy cam with Carl Zeiss lens (4.0 Megapixel), Digital screen ruler- M B Ruler, Video to image converter software Procedure: i) Physical examination- A thorough assessment of each child was done which included Range of motion :- Hip, Knee and Ankle; Strength of Hip (flexors, extensors, abductors, adductors), Knee (flexors, extensors) & Ankle (dorsiflexors, plantarflexors); Spasticity measurements - Modified Tardieu R1 & R2 ii) Kinematic of Gait Measurement done in the following steps- Subject made to walk on 10 mtr walkway. Videographic data was collected with a Stationary Camera placed at 5 meters distance to record.The videographic data was converted into images using converter software.Changes in the angle of knee flexion & extension at initial contact, midstance, terminal stance and mid swing phases of gait were calculated using Digital Screen Ruler (M B Ruler). iii) The physical findings of strength, spasticity and tightness correlated with the changes in kinematics of gait. RESULT :- On descriptive analysis of each subject it is observed that In all subjects with Jump knee type of gait:- - Ankle remain in plantar flexion in stance - There is sudden shift of knee from flexion in initial contact to extension in midstance and


going back to flexion in terminal stance of stance phase. - But hip always remains in flexion throughout stance phase These findings were correlated with the abnormal findings of spasticity and tightness in knee flexors and plantar flexors. In all subjects with crouch type of gait: - -Hip, knee and ankle always remain in flexion throughout stance. -There is lack of hip & knee extension in mid stance and push off in terminal stance. These findings were correlated with weakness in the plantar flexors and tightness in knee flexors. CONCLUSION: - There are significant changes in the kinematic of jump knee and crouch type of gait, especially in transition from initial contact to mid stance phase of gait. Causative factor for gait deviation in jump knee is tightness & spasticity knee flexors whereas in crouch weakness of plantar flexors is a major factor. KEYWORDS: Gait Analysis, Kinematics, Jump Knee gait, Crouch gait, Cerebral palsy. EMAIL: [email protected], [email protected]



LOW LUNG VOLUME COUGHING: A BOON TO THE PATIENTS WITH SECRETION RETENTION (ACUTE EXACERBATION OF

CHRONIC OBSTRUCTIVE PULMONARY DISEASE) - A SINGLE CASE REPORT

Dr Varoon C Jaiswal, Dr Snehal Ghodey, Dr Kiran Pawar

MAEERS Physiotherapy College, Talegaon (D) Pune

AIM: To mobilize the secretion of the patient with acute exacerbation of COPD using low lung volume cough along with pursed lip breathing OBJECTIVES: 1. To evaluate the patient of acute exacerbation of chronic obstructive pulmonary disease with secretion retention 2. To perform low lung volume cough along with pursed lip breathing 3. To re evaluate the patient after performing the technique (auscultation) PURPOSE OF THE STUDY: To our experience it is difficult for Patients with acute exacerbation of chronic obstructive pulmonary disease to perform airway clearance technique like Active Cycle of Breathing Technique because it is difficult for the patients to perform thoracic expansion exercise in already hyperinflated chest. The period of hospitalization for a patient with acute pulmonary exacerbation is a difficult time to learn Autogenic Drainage. Coughing may cause dynamic collapse of the airways which may make the effort futile. Huffing is also difficult for these patients, probably because of reduced forced expiratory flow rates. Low lung volume cough is performed at reduced transpulmonary pressure and may have the advantage of producing less airway closure in patients with obstructive disease than cough performed with higher transpulmonary pressures. Also according to the theory of equal pressure points low lung volume cough will mobilize the secretions from the peripheral airways to the central airways. Pursed lip breathing will reduce the air trapping & will maintain the stability of the airways. METHODOLOGY: Study design: single case report Demographic data: Age: 70 yrs, Sex: male Occupation: cook Date of admission: 11/10/12 Chief complains: Breathlessness since 1 month, Cough with expectoration since 2 weeks History of presenting illness: Apparently alright 1 month back complain started with breathlessness which was gradual onset & progressive in nature . breathlessness was also associated with cough with expectoration, expectoration was 8 to 10 tea spoons in a day mucoid in consistency . On admission he was prescribed 1)salbutamol 2) amoxicillin 3) doxophyline 4) prednisolone Past History: patient is a known case of bronchial asthma since 30 years & was on symptomatic treatment of a local general practitioner Allergic history: allergic to dust & seasonal variations Personal history: Bidi smoking 2 packs per day since last 30 years On examination: On observation Conscious well oriented Built: chachecxic Inspiratory to expiratory ratio : 1:1 Intercoastal indrawing seen Use of ascesory muscles seen


On palpation Trachea: central Chest excursions: B/L equal on all zones On auscultation: Air entry reduced B/L Coarse Expiratory crackles: inter & infra scapular zones Physiotherapy treatment session: low lung volume cough along with pursed lip breathing was performed (technique given in the flow chart) 2 cycles, session lasted to 5 minutes RESULTS: Post technique (treatment) auscultation: air entry improved & intensity of the crackles was reduced suggesting secretions are mobilized. Subjects feedback: The technique was easy to perform & he was able to remove the secretions easily Note: Although we have not taken any objective outcome measure we feel that it is equally important to document the subjective measures initially, future studies can be done using more objective measures & more rigorous study designs, however single case study gives opportunity to the researcher to document the objective measures, also single case studies are initially required to built up a hypothesis for the future studies. EMAIL: [email protected], [email protected]

Technique used to mobilize the secretions

2 to 3 Pursed lip Breathing

Low lung volume cough at the end of Pursed lip Breathing 2 to 3 times

Low lung volume cough at the end of Pursed lip Breathing 2 to 3 times

2 to 3 Pursed lip Breathing

Once Secretions are in Central Airways, Spontaneous Cough Occurs & the Patients Expectorates



TESTER-RETESTER RELIABILITY AND VALIDITY OF THE MODIFIED VERNIER CALIPER AS AESTHESIOMETER FOR

TESTING TWO POINT DISCRIMINATION

Narkeesh A, Mittal, Neha, Kanimozhi D

Department of Physiotherapy, Punjabi University, Patiala ABSTRACT: The study was based on tester-retester reliability and validity of the Modified Vernier Caliper for correlating two point discrimination at different parts of the body. In this study, a comparison and correlation was done in measuring two point discrimination in same aged 30 young adult males and females at face (over eyebrow, cheek, lateral Mandible) trunk ( lateral to umbilicus, Anterior Superior Iliac Spine, Inferior angle of scapula) palm ( 1st dorsal interosseus muscle, distal phalanx thumb, distal phalanx little finger) and foot ( Medial foot, 1st –2nd metatarsal interspace, tip of the great toe). Karl Pearson Correlation was done to determine the correlation between all the variables of the two examiners. The correlation coefficient was r= 0.98. The value was found to be highly significant with P< .005. Validity was checked to satisfy four criteria, Face validity, Content validity, Criterion related Validity and Construct Validity. The result shows that there was no significant difference between male and females in variables of eyebrow, cheek, Inferior scapula, TDP, LFDP, Tip GT and the some significant difference between two genders was found in regions of lateral mandible, lateral umbilicus, iliac crest, 1st DIM, medial foot and 1-2 MTS. Karl Pearson Correlation showed highly significant results (p<.005) between all the variables with Modified Vernier Caliper and Paper Clip and the correlation coefficient was r= 0.98.

KEYWORDS – Two point Discrimination, reliability, validity, proprioception, sensory integrety, sensation. EMAIL: [email protected]

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