Current Issue : [International Journal of Physiotherapy 2017; 4(3) : 139-200] RSS

Volume 4 Issue 3 Index


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Maryam M. Almandil, Makiah Sadek, Surreya Mahomed

DOI : 10.15621/ijphy/2017/v4i3/149063

Pages : 139-146

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Background: Compliance depends on the caregiver and the health care professional committing to the same objectives.Compliance with the prescribed physical therapy (PT) home program is a significant contributor to treatment success.
Methods: One hundred caregivers were invited to fill in a questionnaire after the explanation of the procedure, and signing the consent form. The questionnaire explored factors affecting compliance including nature of the exercise, physical and emotional stresses on the caregiver, and the role of PT in teaching and counseling the caregiver.
Result: Ninety-one participants out of the 100 were committed to administering the exercises with their children. Despite this, there was a discrepancy in either the frequency of repeating the exercises per day or the content of the exercise program when compared with the exercise program prescribed by the therapist. Some of the primary reasons for these differences were the pain experienced by the child when exercising (71%), having other family commitments (57%), not having the time to administer the home program (37%), and lacking skills or equipment to administer the exercises (34%).
Conclusion: Adherence to treatment is a complex act that requires an understanding of treatment approach, having the confidence in one’s skills to administer the unsupervised home program and the existence of a support system both in the hospital and at home that can provide aid when needed. It is the PT role to address all these issues when prescribing a home program to meet treatment objectives.
Keywords: Compliance, physical therapy, caregiver, Pediatrics, children with neurological conditions, exercise.

Shōbo A, Kakizaki F

DOI : 10.15621/ijphy/2017/v4i3/149065

Pages : 147-151

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Background: Poor posture is detrimental to breathing. Our purpose was to investigate the effect of upright and hunchbacked sitting on thoracic configuration and changes in the volume of the thorax during quiet and volitional deep breathing.
Methods: The participants were 11 healthy men with a mean age of 21.6 years, mean body mass of 59.8 kg, mean height of 169.7 cm and a body mass index of 20.7 kg/m2. Eighty-four reflective markers were placed on the trunk. Three-dimensional motion analysis measured the volume within the hemithoraces. To calculate upper and lower thoracic volumes, six imaginary hexahedra were visualized using four reflective markers for each on both aspects of the thorax. Each hexahedron was divided into three imaginary triangular pyramids to calculate positional vectors. Finally, the volume for the hexahedra and triangular pyramids was calculated. Upper thoracic volume encompassed a space from the sternal notch to a midpoint on the ventral aspect of the third rib and the lower thoracic volume from the xiphoid process to the midpoint on tenth rib’s dorsal aspect.
Results: In hunchbacked sitting during quiet breathing the left lower hemithorax yielded a significantly larger volume (p=0.003), and both breathing patterns during inspiration and expiration yielded a significantly greater change in thoracic configuration (p=0.01, p=0.016).
Conclusion: Findings suggested that, in a hunchbacked sitting, there was decreased thoracic asymmetry with re-establishment of thoracic vertebral alignment, consequently stabilizing the sitting position, but breathing was suppressed and tidal volume decreased. Physiotherapy should aim at ensuring correction of hunchbacked posture and maintenance of thoracic symmetry.
Keywords: thoracic volume, hemithorax, three-dimensional motion analysis, hunchbacked sitting, quiet breathing,
volitional deep breathing.

Naushin Q, Shweta M, Annamma V

DOI : 10.15621/ijphy/2017/v4i3/149066

Pages : 152-159

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Background: Aging is a physiologic process that affects all of our body systems. It is characterized by a physiological decline in bodily functions. Physical fitness helps to maintain a good quality of life. Thus we need to study the effect of physical activity on one's physical fitness. The main aim of our study was to compare physical fitness in community-dwelling elderly and institutionalized elderly using Senior Fitness Test (SFT). This test assessed strength, flexibility, balance and endurance. These components are frequently used in one's daily activities and thus helpful to evaluate physical fitness. Since there is an increase in the number of elders becoming institutionalized, it is imperative to understand if there is a difference in demands on their bodily systems which will affect their fitness parameters, hence this study was undertaken.
Methods: Two groups were selected (n=40) which included 20 individuals from the community and 20 from an institution. Their fitness level was evaluated using Senior Fitness Test (SFT) which had six components to assess upper body strength and upper body flexibility, lower body strength and lower body flexibility, 8 feet test, 6-minute walk test.
Result: Comparison of SFT components was made by using unpaired t-test and Mann-Whitney test. Analysis of this study revealed significant difference in lower body strength (p value=0.0028), 8 feet test (p value=0.0205) and 6-minute walk test (p value=<0.0001) which was better in community-dwelling elderly than institutionalized elderly. Also, upper body flexibility (p-value = 0.4477) and lower body flexibility (p-value =0.0766) were better in community-dwelling elderly though was not statistically significant.
Conclusion: The current study suggests that community-dwelling elderly have better lower body strength, dynamic balance and aerobic endurance in comparison to institutionalized elderly of the same age group. Thus, it can be said that staying in institutions, in a restricted environment with less amount of physical activity has a negative impact on one's functional and physical independence.
Keywords: Physical fitness, Community-dwelling elderly, Institutionalized Elderly, Senior Fitness Test (SFT).

Konstantinos Zemadanis, Theodoros Betsos, Dimitris Mandalidis

DOI : 10.15621/ijphy/2017/v4i3/149068

Pages : 160-167

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Background: There is limited evidence to support the therapeutic effect of Manual Therapy on Hip Osteoarthritis (HOA) patients. The purpose of this study was to investigate whether implementation of weight-bearing mobilization-with-movement (MWM) and auto-mobilization had a significant improvement in pain and functionality after a series of sessions.
Methods: Forty patients 50-80 years of age, with HOA, were randomly assigned into two groups. Patients in the treatment group received MWM in standing position and auto-MWM for two weeks, while control patients received a Sham form of MWM. Pain and functionality were measured at baseline, post-treatment and three months’ follow-up,using the Visual Analogue Scale (VAS) and the Lower Extremity Functional Scale (LEFS). Mixed ANOVA was used to examine possible differences between treatment phases and between groups, but also interactions among Group and
Time factors.
Result: The present findings revealed a significant interaction between factors and significant main effects of each Time and Group factors on pain and functionality. The treatment group showed improved post-MWM VAS and LEFS scores compared to baseline scores (p<.001), and improved follow-up MWM and LEFS scores compared to post-MWM scores (p<0.001). In control group, no significant differences were found on either of the post or follow up VAS and LEFS scores compared to baseline scores (p>.001). Differences between groups were significant in post-treatment and follow-up scores (p<.001).
Conclusion: Our findings suggest that weight bearing-MWM and auto-MWM are a significant treatment approach,improving pain and functionality in hip osteoarthritis patients.
Keyword: Mobilization with movement, Hip, Osteoarthritis, Auto mobilization, Manual Therapy.

Mohamed Ibrahim Fathallah Abdelhay, Mohamed Hussein Elgendy, Yasser Ramzy Lasheen

DOI : 10.15621/ijphy/2017/v4i3/149068

Pages : 168-172

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Background: Postural hypnosis can lead to cervical pain or bad cosmetic appearance.There is a lack in the literature supporting the efficacy of spinal mobilization techniques in restoring normal thoracic curvature.Mulligan and Maitland's mobilization were used to improve range of motion and referred pain not to restore normal kyphotic angle. The purpose: this study was conducted to compare the efficacy of Mulligan and Maitland spinal mobilization on a kyphotic angle in postural kyphosis. Subjects: seventy-five male subjects with postural kyphosis their age (17-21) years were included in the study by initial postural examination and were randomly assigned into three equal groups.
Methods: Group I each subject in this group received mulligan mobilization in addition to back exercises as conservative treatment, Group II each subject in this group received Maitland mobilization in addition to back exercises as conservative treatment, Group III this group was considered as a control group. Subjects within this group will perform exercises only as a conservative treatment. Kyphotic angle was measured by using formetric raster-stereography pre and post treatment.
Result: The result of the study showed a significant effect of Mulligan mobilization in reducing kyphotic angle in patients with postural kyphosis p-value was (0.001), and there was no significant effect on Maitland mobilization on a kyphotic angle and the p-value was (0.256).
Conclusion: Mulligan mobilization is effective in restoring normal kyphotic angle in cases of postural kyphosis.
Keywords: Mulligan, Maitland, Mobilization, Kyphotic angle, Postural kyphosis.

Kabir Isah Mayana, Naziru Bashir Mukhtar, Nura Abubakar

DOI : 10.15621/ijphy/2017/v4i3/149070

Pages : 173-177

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Background: Neck pain has been reported as a prevalent musculoskeletal disorder globally with more than half of the general population being affected once or more within their life span.
Methods: A randomized clinical trial research design was used which investigated the immediate effect of cervical manipulation on neck pain and cervical range of motion among patients with chronic mechanical neck pain. 20 male and female participants between the ages of 26 to 60 years with chronic mechanical neck pain attending physiotherapy clinics were recruited. They were randomly assigned into two groups (A and B) of 10 patients each. Group A received soft tissue massage, and cervical manipulation and group B served as the control group, and they received only soft tissue massage. There were two outcomes measured; Pain intensity was rated using visual analog scale (VAS) before and immediately after the intervention. Pre and Post intervention measurements of cervical spine range of motion using Goniometer were also taken.
Results: Findings of the study revealed significant immediate improvement of pain and Cervical Range of Motions (p<0.05) in all dimensions in the experimental group while Pain, flexion and right side Cervical flexion significantly improved in the control group. It was also found out after comparing the outcomes between the two groups that, the experimental group had significantly (p<0.05) better improvement than the control group in post-intervention pain, cervical flexion, cervical extension and cervical (right and left) lateral rotations.
Conclusion: Cervical manipulation is effective in immediate pain relief and improvement in cervical range of motion in patients with mechanical neck pain.
Keywords: Cervical, Manipulation, Mechanical, Neck Pain, Range of Motion, Outcomes.

Neeti Christian

DOI : 10.15621/ijphy/2017/v4i3/149071

Pages : 178-183

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Background: Headache is a common condition which physiotherapists have to deal with in clinical practice.Headaches which arise from the cervical spine are termed as Cervicogenic headaches (CGH), and these types of headaches are common form of a chronic and recurrent headache.The diagnostic criteria for CGH are outlined by the IHS (International Headache Society). The upper cervical joints, namely the occiput-C1 and C1-C2 segments are the most common origin of pain. Office and computer workers have the highest incidence of neck disorders than other occupations; the prevalence of neck disorders is above 50% among them. The purpose of this study is to find the effectiveness of Mulligan’s SNAG technique (C1-C2) and Maitland’s technique (C1-C2) in CGH and to compare these manual therapy techniques (Mulligan’s SNAG technique and Maitland’s technique) with a control group.
Methods: 30 subjects were selected for the study among them 23 subjects completed the study. The subjects were randomly allocated to 3 groups. The range of motion (ROM) and severity of a headache were assessed pre and post intervention using FRT and HDI respectively.
Result: The comparison revealed that SNAG group had a greater increase in cervical rotation (p<0.01) range than the Maitland’s technique and control groups. The mean value between pre-post differences shows a decrease in severity of headache among all three groups. The significant difference between 3 groups was found through Tukey’s post hoc test using ANOVA method (Group A versus Group C; p<0.01 and Group B versus Group C; p<0.05).
Conclusion: The present study suggested that C1-C2 SNAG technique showed statistically significant improvement in reducing headache and disability when compared to the Maitland’s mobilization technique among cervicogenic headache subjects.
Keywords: A cervicogenic headache, FRT, Manual therapy, Mulligan’s SNAG technique, Maitland’s technique, Computer workers.

Priti Nisheet Agni, Vivek Kulkarni

DOI : 10.15621/ijphy/2017/v4i3/149072

Pages : 184-190

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Background: Weakness presents serious compromise to movement function in hemiplegics. Despite the correlation between weakness and impaired function, a clear relationship between strength and function needs more exploration. This study evaluated compared to strength and functional training alone with combined strength and functional training in rehabilitation of upper extremity in stroke patients.
Methods: Forty-five patients with history of stroke of duration 3weeks-6months who could initiate shoulder flexion, abduction, elbow flexion and extension, wrist and finger movements were included in the study and randomized into three groups
Group-I - Strength-training
Group-II - Functional-task-related training
Group-III - Combined Strength and Functional-task-related training for the upper extremity
Patients with cognitive impairments, musculoskeletal complications and with the previous history of hemiplegia were
Outcome Measures used: Fugl-Meyer, Chedoke-Arm and Hand-Inventory, Dynamometer and MMT Interventions were given 3days/week for 6weeks. Subjects were evaluated at 0, 3 and 6weeks.
Result: All the three groups showed improvements in Fugl-Meyer (p<0.005). Group, I showed improvements in Dynamometer and MMT (p<0.005), but less functional gain, whereas group II showed improvement in Chedoke (p<0.005), but without adequate strength gain. Group III showed improvements in MMT (p<0.005), Dynamometer (p<0.005) and Chedoke (p<0.005), suggesting increased strength with improved functional performance.
Conclusion: Combined strength and functional task related training improved both functional motor performance and strength and led to more effective rehabilitation.
Keywords: Stroke, Strength-training, Functional-task related training, Fugl Meyer Assessment of Physical Performance, Dynamometer.

Varsha Soni, Hutoxi Writer

DOI : 10.15621/ijphy/2017/v4i3/149072

Pages : 191-195

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Background: Current available standardized clinical balance assessment tools are used for screening. BESTest helps us identify the specific system that might be responsible for balance dysfunction with aging.
Methods: An observational single point cross-sectional study. Healthy subjects (N=120) Young age group (20-40 yrs),Middle age group (41-60 yrs), Old age group (61-80yrs). Quota sampling. Total BESTest score and a Total score of each of 6 components of BESTest were compared across the three age groups.
Results: Non- parametric Kruskall Wallis test. Post hoc test study of Total BEST Score H=48.88 (p value <0.0001) showed a significant difference in young adult as compared to Middle aged adult (p value <0.001) and older adults (p value <0.001). Similar post hoc test study with a P value < 0.0001 were observed in biomechanical constraint H=32.10,Stability limits or Verticality H=25.11 and Anticipatory control score H=19.83. Post study of reactive postural response H=41.17 and Sensory Orientation H=28.14 (p value <0.0001) showed a significant difference in Older adults as compared with Young Adults and Middle age adults. Post Study of Stability in Gait H=51.00 (p value=0.0001) showed
significant difference across the three age group.
Conclusion: Total BEST score and three balance components start getting impaired by middle age. Reactive postural responses and sensory orientation diminish in older adults. Stability in gait shows a steady decline with aging. Our study concludes that middle age is critical aging and changes start appearing by middle age. Future studies are needed to observe the effect of an exercise program designed to target specific component of BESTest.
Keywords: Aging, Postural control, Balance Assessment, BESTest, Young Age, Middle Age and Old Age.

Abdul Latheef K.E, Thangadurai C, Shaikhji Saad Mohamed

DOI : 10.15621/ijphy/2017/v4i3/149074

Pages : 196-200

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Background: Balance is the ability to maintain body’s center of mass over its base of support. Impairments of balance are common. The purpose of this study was to assess the effect of age and gender on Mini-BES Test balance score among healthy adult subjects.
Methods: A cross-sectional study was done, including240 healthy adults. Balance was assessed using Mini-BESTest and data was analyzed for the effect of age and gender on balance scores using two-way ANOVA. The comparison between male and female age groups was analyzed using Unpaired ‘t’ test.
Result: The inferential statistics of two-way ANOVA had shown the mean ±SD of balance score was 27.85 ± 0.36, 27.5 ± 0.5,27.5 ± 0.5, 26.45 ± 0.5 for Group1,2,3 and 4 respectively with F = 2.643 (p<0.05). This result suggests that there was a statistically significant change in balance score between all age groups except group 2 versus 3.The mean ± SD of balance score for males was 28, 28, 27.13, 26.16 ± 0.71 with the F value = 78.97 (p<0.05) and for females was 27.7 ± 0.465, 27.03 ± 0.18, 27, 26 with F = 235.193 (p<0.05). This result suggests that there was a statistically significant change in balance score among all age groups for both genders. Inferential statistics of unpaired ‘t’ test had shown the mean ± SD of balance score was 27.325 ± 0.927, 26.93 ± 0.657 for total male, total female subjects from all groups respectively.
It suggests the difference between males and females is statistically significant (p= 0.0002).
Conclusion: The age and gender related balance evaluation by using mini BESTest showed that balance declines as age increases in both gender, but decrement varies differently among gender.
Keywords: Balance, mini-BESTest, age-related balance, gender-related balance.