Current Issue : [International Journal of Physiotherapy 2017; 4(4) : 201-216] RSS

Volume 4 Issue 4 Index


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Saurabh Kumar, Narkeesh A, Shefali Gambhir

DOI : 10.15621/ijphy/2017/v4i4/154707

Pages : 201-206

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Background: Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that can produce low back pain, leg pain, and weakness. Many treatment approaches are used for its treatment. An integrated exercise approach has been employed in this case, and its effects pre and post treatment has been compared.
Case Summary: A 48-year-old female presenting with a complaint of pain in the lower back region which was radiating to both lower limbs. She also had difficulty to perform household work like bending, sitting and standing. After taking medicine for two months, the patient didn't get any relief and then she comes in Physiotherapy OPD. After the complete physical examination and assessment, secondary lumbar spinal stenosis was diagnosed. The benefits of integrated exercise protocol on LSS were reported, and treatment protocol was planned according to the identified problem areas of the patient. An intervention of 21 days (20-40 minutes per day, five days per week for three weeks) was given to the patient and improvement was taken on baseline evaluation and 11th day and 22nd day of post-intervention.
Outcome measures: The Oswestry Disability Questionnaire observed the recovery of the patient, Modified Schober Test, Numeric Pain Rating Scale, SLR and Slump test.
Conclusion: Considerable improvement was seen in Pain intensity, neural flexibility, ROM and Quality of life after the rehabilitation. It was observed that the integrated exercise protocol has helped in improving the patient with LSS.
Keywords: Lumbar spinal stenosis, Integrated Exercise Protocol, QOL, neural flexibility, Lumbar ROM.

Jinal A. Mamania, Deepak B. Anap, Dhanashree Tanksale

DOI : 10.15621/ijphy/2017/v4i4/154708

Pages : 207-211

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Background: Measuring angles and movement is an important aspect of clinical assessment. Over the years, various methods have been used to measure the angles. Image based smartphone goniometer offers an easy and non-invasive method for measuring craniovertebral and cranial horizontal angle. However, the validity of this approach has not been established yet. The purpose of this study was to investigate the validity and reliability of a smartphone based application, by comparing the results of the application and ‘AutoCAD®’ software.
Methods: Convenient sampling of asymptomatic participants (Males=4 and females =16) who met the inclusion criteria were examined by two researchers for craniovertebral (CVA) and cranial horizontal angle (CHA) using ON Protractor smartphone application and ‘AutoCAD®’ software. The third examiner analyzed the anthropometric and descriptive data. Validity and reliability were measured using intraclass correlation coefficients (ICC) and p-value.
Result: Good to excellent Intra-rater and inter-rater reliability was demonstrated for CVA and CHA when ON Protractor mobile application and AutoCAD® were compared, with ICC values 0.879 and 0.991 respectively.
Conclusion: Smartphone mobile application-ON Protractor is a reliable tool to measure craniovertebral and cranial horizontal angle.
Keywords: Smartphone application, smartphone, craniovertebral angle, cranio-horizontal angle, reliability, validity.

Heena Kaushal, Narinder Kaur Multani

DOI : 10.15621/ijphy/2017/v4i4/154709

Pages : 212-216

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Background: Menstruation being an inevitable part of a girl’s life and more so, an important indicator of normal physical, physiological and functional well-being. Female athlete who engages in high-intensity exercise is at risk as a consequence of the hormonal change, which results in menstrual dysfunction, subsequently; the athlete is at risk for compromised skeletal integrity. The objective of the study is to find the prevalence of menstrual dysfunction among female athletes of Punjabi University, Patiala, to assess the bone mineral density in female athletes and to examine the relationship of Bone Mineral Density with Menstrual dysfunction in female athletes.
Methods: The present study evaluated the menstrual status and its association with Bone Mineral Density in 76 adolescent female athletes. Convenient random sampling was adopted to recruit athletes by inclusion and exclusion criteria.
Result: The percentile analysis of menstrual dysfunction is found to be 59.3% Out of 59.3% population with menstrual dysfunction, 55.5 % have oligomenorrhea, 28.9% have amenorrhea, and 15.5% have polymenorrhea. In this study population, the mean age of menarche is 13.81. Out of 76 female athletes, 35 have normal BMD ranges whereas 41 are having lower BMD ranges. The association of bone mineral density was found to be non-significant with both stress fracture (X2 = 4.38, p= 0.3570), and epimenorrhea (X2 = 4.49, p = 0.3437). The analysis of Pearson's correlation coefficient (r) suggested a negative association between menstrual function with Bone Mineral Density (-0.06292 at 0.05 levels). The result found to be statistically non-significant; therefore, any change in menstrual function is not associated with Bone mineral density.
Conclusion: Common menstrual dysfunctions reported were: oligomenorrhea, polymenorrhea, amenorrhea, and amenorrhea. However, pre-menstrual syndrome (PMS) and dysmenorrhea were specifically found to be very high in prevalence i.e. 94.7% and 92.1% respectively. This dysfunction may be related to the intensity of training and body’s physiological response to it.
Keywords: Menstrual function, Bone mineral density (BMD), stress fracture, epimenorrhea, pre-menstrual syndrome (PMS) and dysmenorrhea.

Akira Shobo, Fujiyasu Kakizaki

DOI : 10.15621/ijphy/2017/v4i4/154711

Pages : 217-221

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Background: The purpose of this study was to investigate the effects of asymmetric chest volume depending on inspiration load using 3-dimensional motion analysis in a sitting position.
Methods: The participants were 13 sedentary healthy men with a mean age of 21.6 years, mean weight of 58.2 kg, mean height of 169.1 cm and a mean body mass index of 20.3 kg/m2. Using 3-dimensional motion analysis, changes were assessed in the upper thorax defined as the anterior position from the midpoint of the total chest volume from the sternal notch to the 3rd rib, and the lower thorax defined as the posterior portion from the midpoint of the total chest volume from the xiphoid process to the 10th rib.
Result: During both quiet breathing and deep breathing, and under any of the intake loads investigated, the upper right thorax exhibited a significantly larger change in chest volume than the upper left thorax(p=0.013, p=0.009,p=0.005,p=0.005). Conversely, the lower left thorax exhibited a significantly larger change in chest volume than the lower right thorax (p=0.009, p=0.005, p=0.013, p=0.009).
Conclusion: The results of the current study, suggested that about chest configuration in the sitting positions, inspiration loads are larger in the upper right thorax and the lower left thorax than they are in the upper left thorax and lower right thorax.
Keywords: Three-dimensional motion analysis, thoracic volume, hemithorax, inspiration load, upright sitting, breathing

Dipika P. Shah, Arun G. Maiya

DOI : 10.15621/ijphy/2017/v4i4/154717

Pages : 222-228

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Background: Growing childhood obesity epidemic is concerning the health of future generation in any country. Today’s competitive world is increasing the never ending pressure on children to excel in academic performance to ensure bright future. Hence, it is the need of the hour to understand the correlation between obesity and academic performance for implementation of the policies related to obesity prevention and treatment.
Methods: 1034 school children were taken randomly according to inclusion and exclusion criteria, and they were divided into two groups: a) 5-11 years and b) 12-18 years. BMI (BMI), Waist Circumference (WC), the Waist-Height ratio (WHtR) and SSFT (Sum of Skinfold thickness) were taken to measure obesity, and the class teacher evaluated academic performance.
Results: The prevalence of obesity when assessed by WC revealed highest values as compared to Waist-Height ratio, IOTF-BMI and SSFT. Spearman correlation between obesity (WC) and academic performance revealed that there was a significant negative moderate correlation in urban boys (r = -0.4, p<0.05) and girls (r = -0.3, p<0.05) of 5 -11 years’ age-group. There was no significant (r ranging from -0.02 to -0.7, p>0.05) correlation between obesity and academic performance in boys and girls of 12-18 years’ age-group.
Conclusions: It is also concluded from the present study that obesity and academic performance of school children were negatively correlated in boys and girls of 5 -11 years of age but it was not found in 12-18 years of age. Influence of various confounding factors could not be isolated which could have also impacted the academic performance of the child.
Keywords: obesity, academic performance, school-children, body mass index, waist circumference, waist-height ratio.

Nishita Gandhi, Rupali Salvi

DOI : 10.15621/ijphy/2017/v4i4/154718

Pages : 229-235

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Background: A pronated foot can produce changes in the lower limb kinetic chain. This can affect the gait and increase energy expenditure. However, the relationship between pronated foot and other static alignment factors remains poorly understood. Hence, the objective was to correlate pronated foot with pelvic inclination, femoral anteversion, Q-angle and tibial torsion.
Method: An observational study was performed on 60 subjects in the age group of 18-30 years with a BMI of not more than 30. Foot Posture Index was performed on the subjects, and people with a score of +6 or more were selected. Pelvic inclination, femoral anteversion, Q-angle and tibial torsion were measured. Correlation between the Foot Posture Index score and the above four static alignment factors was done using Graph Pad Prism 7 (Pearson’s correlation coefficient and Spearman’s correlation coefficient).
Results: There was no significant correlation between Pronated foot and Pelvic inclination (r-value = 0.03309, p-value = 0.8018), Pronated foot and Femoral anteversion (r-value = 0.2185, p-value = 0.0934) Pronated foot and Q-angle (r-value = 0.1801, p-value = 0.1685), Pronated foot and Tibial torsion (r- value = -0.1285, p-value = 0.3277).
Conclusion: There is no significant correlation between foot pronation and pelvic inclination, femoral anteversion, Q-angle and tibial torsion. However, the correlation between these factors cannot be completely ignored, and thus, further studies and literature are required to prove the same.
Keywords: FPI, pelvic inclination, femoral anteversion, tibial torsion, Q-angle.

Tyler Harrigfeld, Trent Jackman

DOI : 10.15621/ijphy/2017/v4i4/154720

Pages : 236-240

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Background: Sporadic inclusion body myositis is an autoimmune and degenerative disorder of skeletal muscle that affects people at random. It most commonly begins as progressive weakness and atrophy of lower extremity musculature, beginning with the proximal leg. These impairments in body structure adversely affect the performance of functional activities and mobility, resulting in a progressive decrease in independence and participation both at home and in the community. Physical therapy attempts to minimize these effects through educational and procedural interventions focused on treating impairments and limitations. The purpose of this case study was to provide a description of the physical therapy management of a patient diagnosed with sporadic inclusion body myositis.
Case Summary: The patient was a 66-year-old male who was diagnosed with sporadic inclusion body myositis with a chief complaint of weakness and fall risk. He presented with generalized lower extremity weakness and atrophy of bilateral quadriceps, as well as impaired balance and increasing fatigue with activity. Therapeutic exercise, home exercise program, balance, gait, and stair training were delivered to address these impairments. Patient outcomes showed improvement in balance and safety with functional activities.
Discussion: The patient was seen for seven visits that were 45 – 60 minutes in length, over a five-week period. The patient made subjective reports of improvement in functional activities and balance; however many objective outcome measures could not be reassessed. There is a need for further research on this population to determine the effectiveness and parameters of physical therapy interventions.
Conclusion: Physical therapy may have helped improve balance as well as subjective reports from the patient of increased feeling of confidence while navigating stairs.
Keywords: Myositis, Physical Therapy, Balance, Rehabilitation, Weakness.

Saad Saleem, Muhammad Sarfraz Khan, Varisha Kabir, Nabeel Baig

DOI : 10.15621/ijphy/2017/v4i4/154721

Pages : 241-245

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Background: Traumatic brain injury (TBI) is one of the main reasons of death and disabilities globally, mainly in kids and adolescence and is still being considered as an enduring issue in ICUs. There are no definite rehabilitation methods for traumatic brain injury patients. The frequent techniques administered by physiotherapists in ICU are positioning, mobilization, manual hyperinflation technique (MHT), percussion, vibrations, suction, cough, and breathing exercises.
Case Summary: This study was done in the Medical ICU at Liaquat National Hospital and Medical College, Karachi, Pakistan. The chief complaints of the patient was gunshot injury to the right temporal region. The patient was diagnosed with right front parietal contusion with a fracture of the right temporal bone, subarachnoid edema, and midline shift. The physiotherapy interventions given to the patient were Chest Physical Therapy (CPT) with Zero-pressure Manual Hyperinflation and percussions. Once the ICP issues were controlled, manual hyperinflation with 30 cm of H2O, modified postural drainage, minimal–handling saline suctioning were applied. After extubation, CPT included Active Cycle of
Breathing Techniques (ACBTs), volume oriented incentive spirometry, motor relearning program, and mobilization. The outcome measures were secretion status, modified rancho los amigos level of cognitive functioning scale, and arterial blood gas analysis.
Results: The patient’s secretions status improved from P1 to M1, FiO2 was improved from 40% to 21%, chest wall volume was increased from 200 cc/sec to 600 cc/sec, and RLA level increased from I to VIII.
Conclusion: The case study presents that physiotherapy interventions used in intensive care units may prevent pulmonary complications in sufferers with traumatic brain injuries. It also suggests that early mobilization should be done to improve cognitive functioning and behavior. This study may also indicate that the earlier the patient is started with mobilizations and rehabilitation, the less costly it will be for the patient.
Keywords: Traumatic brain injury, Chest Physical Therapy, Postural Drainage, Manual Hyperinflation, Mobilization, Motor Relearning Program.

Muhammad Salman Bashir, Mohammad Reza Hadian, Gholamreza Olyaei, Saeed Talebian, Rabiya Noor, Syed Asadullah Arslan

DOI : 10.15621/ijphy/2017/v4i4/154723

Pages : 246-252

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Background: In physical therapy, usually the effects of treatment on any condition will be evaluated based on the mode of action on the target tissue. Some treatments will have direct and indirect effects. Due to indirect effects, there may be changes in other tissues or systems in and around the target tissue. The interaction between target, effect, and action was studied under TEA model. In sacroiliac joint dysfunction, Muscle Energy Technique (MET) and Spinal Manipulation Therapy (SMT) were proved as useful treatment approaches but one is targeted on muscles (MET) the other targets on joint (SMT). The indirect effects of both the approaches can’t be neglected. This study focused on evaluating
indirect effects of SMT.
Methods: A pilot study was conducted to see the effect of Spinal Manipulation Therapy on muscles (Transverse Abdominus, Internal Oblique) when applied in patients with sacroiliac joint dysfunction. 44 subjects diagnosed with sacroiliac joint dysfunction were recruited in the study. Resting thickness was measured by ultrasound before and after Spinal Manipulation Therapy. SPSS version 17 was used for statistical analysis. Paired t-test compared pre and post test results.
Results: After conducting Pilot study revealed that Pre resting thickness of Transverse Abdominus and Internal Oblique is (3.5±0.10) and (5.47± 0.15) Post resting Thickness of TrA (Transverse Abdominus) and Internal Oblique (IO) is (3.90±0.12) and (7.63±0.80) Results are significant as P-Value 0.000 that is <0.05.
Conclusion: Here is concluded that SMT is a useful method to treat muscles through its direct action is on the Sacroiliac joint in Sacroiliac joint dysfunction. So we can use it for treating muscles by applying on joints (Indirect method).
Keywords: Spinal Manipulation, Sacroiliac Joint, Muscle, Pain, Low backache, Ultrasonography.

Priti Agni, Sneha Battin

DOI : 10.15621/ijphy/2017/v4i4/154724

Pages : 253-261

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Background: Physiotherapy is a form of rehabilitation science which helps to make a difference in an individual’s ability to live an active and healthy lifestyle. For many physiotherapists working in India, the primary source of reference is a physician. An aware physician can timely refer patients for physiotherapy who can in turn plan an effective management without making the rehabilitation journey taxing. This article will serve us to know about the interest and acceptance of physiotherapy and also to determine the extent of awareness among general practitioners.
Methods: A sample size of 150 subjects were randomly chosen. The study was conducted in a questionnaire based interview format. All willing general practitioners from various streams along with super specialists were included, whereas interns and unwilling practitioners were excluded.
Subjects were briefed about the study, written consent was taken before hand, and a validated questionnaire was personally given to fill in the details. The response thus obtained, was taken up for further analysis.
Result: From the study, it was learned that there is awareness regarding physiotherapy among general practitioners. With regards to the different streams of physiotherapy, the Orthopedic (36%) and Neurological fields (24%) are the most popular, followed by Cardio respiratory (16%), Sports rehabilitation (14%) and only 6% aware of community-based rehabilitation.
Conclusion: The study revealed that there is full awareness of physiotherapy among general practitioners. Musculoskeletal Physiotherapy showed good awareness among the study subjects. This was followed by NeuroPhysiotherapy, Cardio respiratory and Sports Physiotherapy. However, community-based rehabilitation was least known. Also, physicians believe that prescribing exercises is the main intervention used by a therapist and there is less information regarding the recent advances in rehabilitation.
Keywords: rehabilitation, general practitioners, awareness, physiotherapists, healthcare, medical students.