[International Journal of Physiotherapy 2016; 3(5) : 509-652] RSS



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Nilufer Keskin Dilbay, Mintaze Kerem Gunel, Timucin Aktan, Zehra Guchan, Emine Seda Turkyılmaz, Ozge Cankaya

DOI : 10.15621/ijphy/2016/v3i5/117432

Pages : 509-521

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Background: Cerebral palsy (CP) is the most common cause of physical disability in children and it causes many problems such as motor, sensory and cognitive impairment, and it leads to effect child’s quality of life. There are many of questionnaire for evaluating quality of life but which is reliable, valid and sensitive to age groups children with CP in Turkish. Our study aims to investigate whether the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Quality of Life Inventory (PedsQL) and Child Health Questionnaire Parent Form (CHQ PF-50) scales are reliable, valid, and sensitive in children with Cerebral Palsy among different age groups and impairment levels.
Methods: 105 children with CP, 48 healthy children and their mothers were participated in this study. They were divided into three groups according to their age; as 2-7 years, 8-12 years and 13-18 years. Statistical power analysis was conducted to acquire statistical power at a medium level (80%).
Results: The internal consistency of scales was acceptable and their test-retest reliability was significant (for PODCI, α=0.93 and ICC=0.992, for PedsQL α=0.85 and ICC=0.955, for CHQ PF-50 α=0.92 and ICC=0.975). The findings of their validity indicated that they were significantly sensitive in discriminating healthy children and children with CP (p<0.001). However, the scales could only distinguish age and GMFCS groups in physical functioning domain (p<0.05).
Conclusions: Within the concept of our study, the PODCI, PedsQL, and CHQ PF-50 scales were found reliable, valid, and sensitive in children wıth CP between ages 2-18. The sections regarding the physical functioning domains of these three scales presented sensitive results in accordance with the age and GMFCS levels of the children with CP.
Keywords: Cerebral Palsy, Functional Health Status, Health Related Quality of Life, PedsQL, PODCI, CHQPF-50

Marwa A. Mohamed, Asmaa M. El Bandrawy, Amir A. Gabr

DOI : 10.15621/ijphy/2016/v3i5/117433

Pages : 522-528

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Background: Premenstrual syndrome is a current condition characterized by troublesome symptoms as tension, irritability, depression, headache, anxiety and loss of self-control, so the aim of this study was to investigate the effect of foot reflexology augmented with relaxation training on premenstrual syndrome in adolescent females.
Methods: A sample of 50 volunteers, virgin females diagnosed as premenstrual syndrome was selected from the students of Faculty of Physical Therapy, Cairo University. Their age was ranged between 19 to 23 years with mean value of (21.53±2.27 yrs) and BMI was ≤28 Kg/m² with mean value of (24.04±2.41 Kg/m²).A detailed medical history was obtained to screen other pathological conditions that may affect the results. Females were randomly assigned into two equal groups. Group (A) consisted of 25 subjects who received foot reflexology in addition to relaxation training techniques twice a week for 8 weeks. Group (B) consisted of 25 patients, who received relaxation training techniques only twice a week for 8 weeks. Assessment of all subjects in both groups was carried out before and after the treatment program through heart rate, respiratory rate in addition to plasma cortisol level and daily symptoms report chart.
Results: Showed a statistical highly significant decrease (p<0.001) in heart rate, respiratory rate, plasma cortisol level as well as daily symptoms report score in group (A) while there was a statistical significant decrease (p<0.05) in all variables in group (B).
Conclusions: Adding foot reflexology to relaxation training had a great positive effect on premenstrual syndrome in adolescent females than relaxation training only.
Keywords: Reflexology, mental relaxation, physical relaxation, breathing exercises, premenstrual syndrome, adolescence.

Meena .V, Shanthi .C, Madhavi .K

DOI : 10.15621/ijphy/2016/v3i5/117434

Pages : 529-534

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Background: Osteoarthritis (OA) is a degenerative joint disease and one of the major public health problem that causesfunctional impairment and reduced quality of life. To compare the effectiveness of PNF Hold relax stretching versus Static stretching on pain and flexibility of hamstring following moist heat in individuals with knee osteoarthritis. Hamstring tightness is the major problem in knee osteoarthritis individuals. Therefore the need of study is comparing the effectiveness of PNF Hold relax stretching versus static stretching on pain and flexibility of hamstrings following moist heat in knee osteoarthritis participants. Determining the effects of PNF Hold relax stretching versus Static stretching along with moist heat on pain and hamstring flexibility by VAS and Active knee extension range of motion in knee osteoarthritis individuals.
Methods: 30 subjects with symptoms of knee osteoarthritis were randomly distributed into 2 groups 15 in each group. PNF Hold relax stretching along with moist heat is compared to Static stretching along with moist heat. Pain was measured by Visual Analogue Scale (VAS) and hamstring flexibility by Active knee Extension Range of Motion (AKEROM) by universal goniometer. Measurements are taken pre and post intervention.
Results: The results indicated PNF Hold relax stretching along with moist heat showed a statistically significant improvement in pain (p<0.05) and improvement in hamstring flexibility (p<0.05) when compared to Static stretching along with moist heat.
Conclusion: Subjects with PNF Hold relax stretching along with moist heat showed significant improvement in pain reduction and improving hamstring flexibility than Static stretching along with moist heat.
Keywords: Osteoarthritis, PNF stretching, Static stretching, Moist heat, VAS, AKE-ROM.

Hamada El Sayed Abd Allah Ayoub

DOI : 10.15621/ijphy/2016/v3i5/117435

Pages : 535-539

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Background: A lot of the ambulating children with spastic diplegia were able to walk with flexed hips, knees and ankles this gait pattern is known as crouch gait. The most needed functional achievement of diplegic children habilitation is to be able to walk appropriately. The development of an independent and efficient walking is one of the main objectives for children with cerebral palsy especially those with spastic diplegia.
Method: Twenty children with spastic diplegia enrolled in this study, they were classified into two groups of equal number, eligibility to our study were ages ranged from seven to ten years, were able to ambulate, They had gait problems and abnormal gait kinematics. The control group (A) received selected physical therapy program based on neurodevelopmental approach for such cases, while the study group (B) received partial body weight supported backward treadmill training in addition to regular exercise program. Gait pattern was assessed using the Biodex Gait Trainer II for each group pre and post three months of the treatment program.
Results: There was statistically significant improvement in walking speed in the study group (P<0.05) with significant difference when comparing post treatment results between groups (p<0.05).
Conclusion: These findings suggested that partial body weight supported backward treadmill training can be included as a supplementary therapeutic modality to improve walking speed and functional abilities of children with diplegic cerebral palsy.
Keywords: Diplegia, Backward, Treadmill, walking speed, Cerebral Palsy, Body Weight Support.

Emrullah Hayta, Nur Mine Umdu

DOI : 10.15621/ijphy/2016/v3i5/117436

Pages : 540-546

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Background: Managemen of myofascial pain syndrome (MPS) is a current research subject since there is a small number of randomized studies comparing different management techniques. Multiple studies attempted to assess various treatment options including trigger point dry needling and kinesiotaping. We compared the effects of trigger point dry needling and kinesiotaping in the management of myofascial pain syndome during a 3-month follow-up period.
Methods: In this prospective randomized studyin MPS patients with upper trapezius muscle trigger points, the effects of dry needling (n=28) and kinesiotaping (n=27) was compared with regard to the visual analog scale (VAS), neck disability index (NDI), and Nottingham health profile (NHP) scores measured at the weeks 0, 4, and 12.
Results: Both dry needling and kinesiotaping comparably reduced VAS scores measured at the weeks 4 and 12 and their efficacies were more remarkable at the week 12 (p<0.05). These interventions significantly reduced the NDI and NHP score and their effects were also more remarkable at the week 12; however, dry needling was found more effective (p<0.05).
Conclusion: Overall, in current clinical settings, during the management of MPS, pain can be reduced comparably by both dry needling and kinesiotaping; however, restriction in the range of motionin neck region and quality of life are more remarkably reduced by dry needling. Both dry needling and kinesiotaping can provide an increasing effectiveness up to 12 weeks.
Keywords: Myofascial pain syndrome, dry needling, kinesiotaping, pain, Nottingham health profile, neck disability index

Ponmathi .P, Nair Shalini Krishnan, V.P.R. Siva kumar

DOI : 10.15621/ijphy/2016/v3i5/117437

Pages : 547-551

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Background: Gynaecological surgeries refer to surgery on the female reproductive system. Woman may undergo a Gynaecological surgery for different reasons, including; Uterine prolapse, Cancer of the uterus, cervix, or ovaries, Endometriosis, Bleeding, Adenomyosis etc.Gynaecological surgeries includes procedures such as hysterectomy, oopherectomy, salphingectomy, myomectomy, ovarin cystectomy, etc. The Physiotherapy referral is essential in such cases but most of time the patients are not referred for Physiotherapy. Hence the current study was undertaken. Thus the objective is to find out the Effectiveness of Physiotherapy management over quality of life in post-operative Gynaecological patients.
Methods: 32 females who underwent Gynecological surgery were taken into the study and divided conveniently into Group A and Group B consisting of 16 females each. Physiotherapy intervention given to Group A includes- Breathing exercises, Coughing techniques, Circulatory exercises, Knee rolling, log rolling, patient made to sit, Abdominal exercises, Pelvic tilting, Getting in and out of the bed, Pelvic floor exercises and mobilization inside the ward, outside the ward and stair climbing where as conventional treatment which includes Breathing exercises and Back care were given to Group B for a period of 5 days. Outcome measures used were VAS (Visual Analog Scale) and ASIS (Abdominal Surgery Impact Scale).
Results: There was a significant difference in post test score of VAS (p=0.0001) and ASIS (p=0.0001) in Group A as compared to Group B.
Conclusion: This study revealed that physiotherapy intervention performed immediately after Gynecological surgery improves quality of life of the patients and a scheduled exercise program benefits the patient more than conventional Physiotherapy management and it should be emphasized to all the post Gynecological surgery Patients.
Keywords: Gynaecological surgery, Physiotherapy, Post Operative, Quality of Life, Hysterectomy, Abdominal Surgery
Impact Scale, Visual Analogue Scale.

Emad T. Ahmed

DOI : 10.15621/ijphy/2016/v3i5/117438

Pages : 552-556

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Background: Physical therapy often is used in the management of work-related low back pain (LBP). Little information, however, is known about work related low back pain that may occur in physical therapy experts themselves. Work related low back agony speaks to one of the real wellbeing issues that happen in well-beings experts. The point of this study is to examine the pervasiveness of work related low back pain in physical therapy experts, and its connection to the way of work.
Methods: One hundred and seven physical therapy experts working at general hospitals at Taif, KSA took part in this study, their age ranged from 25 to 60 years, and they were complaining from low back pain for more than 3 months and their current pain for at least three or more weeks. Every subject was requested to finish the Oswestry Low Back Pain Disability Index Questionnaires that comprised of 15 close-ended inquiries.
Results: We analyzed Data by utilizing descriptive statistics to gauge the predominance of low back pain in physical therapy experts and to explore connection between back pain and hospital facility work. Out of two hundred thirty physical therapist advisor, one hundred and ten (47.8%) physical specialists finished/gave back the surveys. three polls were rejected from investigation since members had missed a few things in filling the survey. In this manner, just information from 107 members was utilized to figure the predominance rates. It was found that the commonness of work related low back pain in physical therapy expert is equivalent 72%. It was found that a connection between the works related low back pain and age, proficient rank, and specialty.
Conclusion: There is a higher occurrence of work related back pain among physiotherapist expert and this may be impacted by age, proficient rank and specialty.
Keywords: Work- Low back pain-Prevalence - Physical therapy- Taif- KSA.

Y. Nissee Neelima Raj, K. Vadivelan, V. P. R. SivaKumar

DOI : 10.15621/ijphy/2016/v3i5/117439

Pages : 557-561

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Background: Individuals with the age of 60 years and above may present with the symptoms of imbalance and body instability. Therefore, balance related activities such as standing, getting up from chair; walking becomes difficult which leads to fall. Also, old people are more prone to frequent diseases, sickness and also have limited regenerative capabilities when compared to other adults. So, the purpose of this study was to find out the comparison of multisensory versus strengthening exercises on functional mobility and balance in elders.
Methods: 45 subjects with good comprehension were selected for the study based on inclusion and exclusion criteria and were randomized into three groups Group A(15), Group B(15), Group C (15) by simple random sampling technique. The subjects in Group A received Multisensory exercises whereas Group B received strengthening exercises and Group C underwent Walking. The subjects were made to do these exercises for five days a week for a total duration of 6 weeks. The baseline values and post –test values were assessed with Timed ‘up and go’ test (TUG) and Guralnik test battery.
Results: The mean difference between subjects trained with Multisensory exercises (Group- A) and Walking (Group-C) is greater than Multisensory exercise (Group-A) and Strengthening exercise (Group B), Walking (Group C)and Strengthening(Group B)for both Timed up and go test (P<0.0001) and Guralnik test battery(P=0.05) (Graph 1, 2). This shows that multisensory exercises are effective compared to strengthening exercises and walking.
Conclusion: In this study, multisensory exercises showed more improvement in mobility and balance. So, multisensory exercise can be considered as an adjunct with other exercises in rehabilitation of the elderly subjects with balance impairment.
Keywords: Multisensory Exercises, Strengthening, balance impairment, Elderly.

Khalid A Alahmari, S. Paul Silvian, Ravi Shankar Reddy,Venkata Nagaraj Kakaraparthi, Irshad Ahmad, Mohammad Mahtab Alam

DOI : 10.15621/ijphy/2016/v3i5/117440

Pages : 562-568

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Background: Hand-grip strength studies with healthy adults have shown correlation between anthropometric variables and hand grip strength. There is dearth in literature in population of Saudi Arabia. The objective of this study is to describe normative data to evaluate the relationship between handgrip strength and other anthropometric variables especially hand length, forearm circumference with regard to dominant hand, among healthy males in Abha, Saudi Arabia, using a Hand held dynamometer.
Methods: A sample of 99 male adults from the population of Abha, Saudi Arabia, ages 20 to 72 years were tested using standardized positioning and instructions. A Hand–held dynamometer was used to measure grip strength in kilograms.
Results: Low to medium correlation (significant) is found between all the variables and HGS. Age is negatively correlated. A stepwise regression predicts that hand length, age, forearm girth circumference are the three significant variables of hand grip strength. An ANOVA proves that hand grip strength is less for subjects above 60 years; hand grip strength is higher for subjects with extra-large forearm girth circumference.
Conclusion: Normative values hand grip strength in population of Saudi Arabia is established through this study. The hand grip strength is influenced by hand length, hand girth circumference as well as age category of the subjects and these variables can be better predictors while clinically rehabilitating hand patients.
Keywords: Handgrip, hand length, forearm circumference, dominant hand, hand held dynamometer

Efthimios J. Kouloulas

DOI : 10.15621/ijphy/2016/v3i5/117441

Pages : 569-574

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Background: Joint contracture is a limitation in the passive or active range of motion (ROM) of a joint, where in addition to the mobility limiting factor the pain is also present. Repetitive pulsed Magnetic Stimulation (rPMS) appears to be an effective, non-invasive and safety solution for treating this condition. Therefore aim of this study was to evaluate the effect of rPMS in treating joint contracture.
Methods: 30 subjects with joint contracture in the knee were enrolled in this study and divided respectively into Treatment and Control group. The treatment group were delivered with rPMS therapy. The control group was delivered with conventional physiotherapy method (ultrasound). The primary outcome measurements were: 1. Mobility evaluation by goniometry (ROM in degrees while performing flexion) and Patient Functional Assessment Questionnaire (PFAQ) for ability to perform Activities of Daily Living (ADL) and 2. Pain evaluation by 10-point Visual Analog Scale (VAS) for pain perception. Absence of adverse events was set as a secondary measure.
Results: The results of the study show statistical difference (p<0.05) between the levels of improvement of all studied parameters while comparing between both groups. The results suggest greater immobility restoration and pain relieving effect of the rPMS in comparison to conventional physiotherapy method.
Conclusion: rPMS an effective and safe non-invasive method for mobility restoration and pain relief in case of joint contractures. This study suggests the method as beneficial and quality of life ameliorating among patients suffering from immobilized joints accompanied by pain.
Keywords: joint contracture, mobility limitation, pain, repetitive pulse magnetic stimulation, mobility restoration, pain

R. Naveendran, S.Yamini, P. Antony Leo Aseer

DOI : 10.15621/ijphy/2016/v3i5/117443

Pages : 575-579

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Background: Low back pain (LBP) is one of the major and commonest musculoskeletal disorders among all age groups with substantial challenges for clinical management. The psychological overlay can be detected only in chronicity of the condition. Current research highlights sub grouping LBP is a priority for target specific treatments.Hence the aim of the study was to categorize subjects into three subgroups of risk using STarT Back Screening tool.
Methods: An observational-follow up study was conducted with subjects of sample size 40 (aged 18 to 65) having low back pain of duration less than one month. The principle investigator administered the screening tool to the subjects. The self- administered Tamil version of 9 items STarT back screening tool was administered. Based on the risk level, counseling was imparted and re analysis of values were done a month later using the same tool.
Results: The mean pre total score is 4.48±1.8 and post total score after a month is 2.03±1.18.The mean pre sub score is 2.28±1.21 and post total sub score after a month is 1.18±0.84.On comparing the pre and post scores, it was found to be statistically highly significant(p-.0005) in total and sub scores.
Conclusion: The study concludes that STarT back screening tool is an easy, simple tool in sub grouping acute low back pain. The tool proved to be efficient in predicting risk in acute low back pain in a short duration of follow up.
Keywords: Acute, low back pain, STarT Back Screening Tool, total score, sub score.

Shanthi C, Chandra A, Vanajakshamma, Madhavi. K

DOI : 10.15621/ijphy/2016/v3i5/117444

Pages : 580-586

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Background: Post surgical mitral valve disease individual focus their cardiac rehabilitation training on two major goal that is to improve cardiac output response exercises and place an important role in determining exercise tolerance and to improve quality of life. Cardiac rehabilitation programs involve prescribed exercise and education however various other method are being used to improve quality of life. But our study to find out the effectiveness of graded aerobic exercise protocol on ejection fraction and quality of life in post surgical mitral valve disease individuals.
Methods: The study design was open label studies total of 100 post surgical mitral valve disease individuals patients from the age group of 20-60 years were recruited from SVIMS hospital. They were randomly divided into two groups. Group I underwent a twelve week structured graded individually tailored exercises. The group II received only none graded (not individualized) exercise training. The ejection fraction and quality of life was measured before and after 12 weeks of exercise training for two groups.
Results: Repeated measures ANOVA was used to compare mean values of continuous variables between baseline and at the time of discharge and three months after surgery for each parameter. Comparison of means between groups was done by the unpaired student t test. Mean age of the subjects was 40.18±10.29. There was a significant increase in the ejection fraction in the group I(61.34±2.49 to 64.4±3.31) compared to with the group II (61.06±2.51. to 61.62 ±2.37.) QOL had improved in group I than group II at p<0.05.
Conclusion: A 12 week structured graded aerobic exercise training significantly improved ejection fraction and quality of life in post surgical mitral valve disease individuals.
Keywords: Rheumatic heart disease, ejection fraction, mitralstenosis, cardiac rehabilitation, graded exercise, and quality
of life.

Ragab K. Elnaggar, Mohammed A. Shendy

DOI : 10.15621/ijphy/2016/v3i5/117445

Pages : 587-593

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Background: Lately, childhood obesity has gained more attention. The present study constructed to compare the effectiveness of aerobic interval exercises and dietary control on plasma adipokines level, lipid profile and the health-related quality of life in overweight or obese children.
Methods: Thirty-seven overweight or obese children at the age from 10-18 years were recruited and randomly classified into aerobic interval exercises (AIE) and dietary control (DC) groups. The Training load for AIE group was eight weeks of an intermittent short high intense burst of exercises throughout a regular training program primarily consisted of treadmill training. Whereas, subjects in the DC group were engaged in a balanced dietary plan. Plasma adipokines, lipid profile, and the health-related quality of life were assessed before and after the intervention.
Results: Both groups were similar at the baseline (p>0.05). Within the AIE group; leptin, adiponectin and all lipid profile measures significantly changed (p<0.05). But, within the DC group, only leptin, high-density lipoprotein cholesterol (HDL-Cho) and low-density lipoprotein cholesterol (LDL-Cho) levels have been significantly changed (p<0.05). Further, the health-related quality of life (HRQL) indicated significant differences within both groups (p<0.05) with regard to both physical and psychosocial health. Finally, significant differences of leptin, HDL-Cho, LDL-Cho levels and the psychosocial health (p<0.05) were recorded between both groups in favor of the AIE group.
Conclusion: However, both aerobic interval training and balanced dietary controlare useful to improve plasma adipokines level, lipid profile, and the HRQL in overweight or obese children. But, aerobic interval training is more helpful.
Keywords: Childhood obesity, Aerobic interval exercises, Dietary control, Plasma adipokines, Lipid profile, Health-related quality of life

Heba Mohamed Embaby, Ghada Ebrahim El Refaye, Gihan Fathi Abdel Aziz

DOI : 10.15621/ijphy/2016/v3i5/117446

Pages : 594-602

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Background: Postpartum sacroiliac joint pain, is a serious problem for the mother, affect the ability to perform daily activities and minimize health-related quality of life. This study aimed to determine the effect of stabilizing exercises and acupuncture on postpartum sacroiliac pain.
Methods: Forty multiparous women with sacroiliac joint pain (SIJP), were included, aged 25 to 35 years, BMI not exceed 30kg/m², parity less than 3 times, and delivered normally, they're assigned into two equal groups. Group (A) performed stabilizing exercises for lumbo-pelvic muscles and acupuncture. Group (B) received only acupuncture, were performed three times per week for two months (24sessions). The assessment throughout the present pain intensity (PPi) and the Oswestery disability questionnaire before and after the treatment.
Results: It revealed a significant decrease in the PPi scores and a significant improvement in functional disability in both groups (A,B). Group (A) showed a significant decrease in the PPi scores and significant improvement in functional disability with percentage of improvement was 75%% & 62.5% respectively more than in the group (B) the percentage of improvement was 40% & 46.7% respectively.
Conclusion: These results indicate that the lumbo- pelvic stabilizing exercises in conjunction with acupuncture were effective adjunct methods in alleviating postpartum sacroiliac joint pain.
Keywords: Postpartum; sacroiliac; pain; stabilizing exercise; Acupuncture; Egyptian females.

K. Vadivelan, T. Manikandan, V. P. R Sivakumar

DOI : 10.15621/ijphy/2016/v3i5/117447

Pages : 603-608

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Background: Energy cost of walking is two times higher in children with cerebral palsy when compared with normal children; this may be due to gait abnormalities.There is a negative influence on physical activity and early onsets of fatigue in activities of daily living are evident in cerebral palsy children and the reason for this is increase in energy cost of walking. Therefore, the treatment techniques which targets on correction of gait abnormalities and Energy conservation during walking are important to maintain orimprove independent functioning.The aim is to find out the effects of using Supra Malleolar Orthosis (SMO) along with co-activation exercise in the increase of gait endurance and also to encourage independent skills and abilities in cerebral palsy child.
Methods: A 14 years child with spastic hemiplegic cerebral palsy was treated with custom made supra malleolar orthotic which was designed with an orthotic support followed with specific exercises, co-activating dorsiflexors and plantar flexors actively and with assistance. The subject was made to do the co-activation exercises 3 days per week for 8 weeks. Step length, stride length, cadence, navicular drop test, medial arch height and calcaneal eversion were measured before starting the treatment and at the end of 8th week.
Results: the results of treatment shows that there is an improvement in 2 minutes’ walk test from 7(pre-test) to 13, step length from 22 (pre-test) to 32,stride length from 36(pre-test) to 47,cadence from 39 (pretest) to 37 after the use of Supra Malleolar Orthosis (SMO) and a co-activation exercises intervention. There was a clear and significant improvement noted in navicular drop test, medial arch height and calcaneal eversion after a period of 8 weeks use of orthosis and exercise intervention when compared with pre-test value.
Conclusion: Orthotic subtalar alignment with co-acticvation exercises for alteration in gait endurance in a child is showing significantly good results in this case study of a child with cerebral palsy. The Co-activation exercise with Supra Malleolar Orthotic support reduces the intensity of symptoms and improved gait parameters in cerebral palsy child.
Keywords: Cerebral Palsy, Supra Malleolar Orthosis, Co-activation exercises, gait.

Ghada M. ALQaslah, Afaf AM Shaheen

DOI : 10.15621/ijphy/2016/v3i5/117448

Pages : 609-618

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Background: This study might have been directed to some degree because of clashing results in the past studies regarding the impacts for different SS protocols on muscle strength and possibility for injury. The objective of the study was to investigate the acute effects of different static stretching (SS) durations (20, 30, and 60s) on isokinetic concentric quadriceps (Q) and hamstrings (H) peak torque (PT), eccentric H PT and conventional and functional H:Q ratios under different stretching conditions and angular velocities (60°and180°/s) in active women.
Methods: Isokinetic tests were performed on 108 active women. A HUMAC system was used to measure unilateral concentric Q and H PT, and eccentric H PT at 60 and 180º/s at baseline and after a bout of H-only, Q-only, and combined H and Q muscles SS. The data were statistically treated using five separate three-way (time x conditions x velocity) ANOVA.
Results: There were no significant differences among groups at baseline (P > 0.05). Significant reductions of all outcome measures have been shown to occur after 30 and 60s of SS (P < 0.05). The highest reductions of concentric Q and H PT, eccentric H PT and H:Q ratios were observed after 60s of SS. With no significant effects with the 20s SS (P > 0.05).
Conclusion: Short-lasting stretching can be done before exercises that require strength. However, since 30s or 60s stretching protocols adversely affect the muscle strength, performance and lower H:Q ratios they are not recommended prior to activities demanding the production of high forces.
Keywords: Static stretch, Isokinetic tests, Muscle strength, Hamstrings-Quadriceps ratios

Mohan Kumar .G, Logabalan .T, Senthil Nathan .C .V, Rajalaxmi .V, Ramachandran .S, Sudhakar .S

DOI : 10.15621/ijphy/2016/v3i5/117451

Pages : 619-624

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Background: Periarthritis or Adhesive shoulder occurs among 7-21% of the population, which was characterized by traumatic stiff shoulders in both active and passive range of actions. The aim of the study was to compare the efficacy between Muscle energy technique (MET) and Mobilization technique (MT) coupled with ultrasound therapy in reduction of pain and increasing functional ability of subjects with adhesive shoulder.
Methods: 30 subjects were randomly assigned for the experimental study by the selection criteria and divided into 2 groups: Group A -Muscle energy technique with ultrasound therapy (METU) and Group B- Mobilization technique with ultrasound therapy (MTU). The period of intervention was 5 sessions per week for 21 days. The therapy progress was evaluated by VAS and SPADI scores pre and post every 7 days of therapy.
Results: The analysis was non-blind randomized experimental study for the subjects with adhesive shoulders. Both the treatment groups showed improvement comparing pre and post treatment, while Group A showed significant difference compared to Group B in pain relief and functional abilities. Statistically comparing the mean values of SPADI of the two treatment groups has indicated METU (28.93) as more efficient than MTU (36.80) at P≤ 0.001.
Conclusion: The current study has concluded that the muscle energy technique coupled with ultrasound therapy imparts more effective solution than the mobilization technique coupled with ultrasound. Hence, this study has demonstrated a better combination therapy regimen for the treatment of periarthritic shoulder the physiotherapists. Similarly, potential of this combination therapy can be explored on other types of ailments demanding physiotherapy.
Keywords: Muscle energy technique, Mobilization technique, Ultrasound therapy, VAS, SPADI scale.

Vengata Subramani Manoharan, Phan Ai Yean

DOI : 10.15621/ijphy/2016/v3i5/117453

Pages : 625-629

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Background: Thoracic outlet syndrome (TOS) is a complex condition characterised by a group of conditions that compress on the neurovascular bundle that enter and leaves the thoracic inlet, interscalene triangle, costoclavicular space and above the pectoris minor that occur above the clavicle. 1-2% is associated with arterial obstruction among the other type of TOS. Symptoms usually annoy extremely by movement of cervical spine and head or by raising upper limb. The main aim of this case report is to reduce the gap in evidence based research and to describe the process and outcomes of conservative management.
Methods: As there is no specific test for TOS, the patient was initially assessed with Adson and Roos test. All these test were positive along with MR angiogram and Doppler to confirm A-TOS. Physiotherapy intervention of 6 weeks with following procedure such as massage, warm up, passive stretching, active stretching, hand grip strengthening and cool down. Pain was assessed using VAS scale, strength was assessed using hand dynamometer. Patient was also taught to palpate her own pulse (radial) before intervention.
Result: After 6 weeks of intervention patients pain intensity according to the VAS scale was 3, and pulse grade was 3+ that shows pain and pulse in the hand and wrist area were improved significantly. Patients hand grip strength is slightly improved compared to pre intervention using TuKey’s multiple comparison test and it is statistically significant in p<0.001, p<0.01 and p<0.05 respectively. Our results have convinced us that particular approach to the treatment of A-TOS.
Conclusion: We concluded that the massage, stretching and hap grip strengthening will improve patient’s condition in Arterial TOS. We also suggested that future research should also focus on arterial TOS due to bony abnormalities and patient’s with arterial luminal defect.
Keywords: Arterial Thoracic Outlet Syndrome, Physiotherapy, Pulse, Hand grip strength, Massage, Stretching

Karthikeyan Selvaganapathy, Roshini Rajappan, Nagaletchumy Supramanian, Syed Abudaheer, Jubish KV, Karthikeyan Rajendran

DOI : 10.15621/ijphy/2016/v3i5/117454

Pages : 630-636

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Background: Obese population is dramatically increasing worldwide. There is a strong association between obesity and low back pain. The 1-month prevalence of low back pain ranges from 30% to 40% in the general population. McKenzie method is commonly used in the diagnosis and management of patients with back pain. The objective of the study is to examine the cardiovascular responses of two common exercises namely, extension in lying (EIL) and extension in standing (EIS) used in the McKenzie system with different repetitions among class I obese subjects.
Method: 50 class I obese subjects (25 males and 25 females) were randomly selected within the age range of 20-40 years. Baseline measures of resting heart rate (HR), blood pressure (BP) and rate pressure product (RPP) were taken before and after exercises. Multiple comparisons were done to analyze the significance within groups. One-way analysis of variance for repeated measures was used to compare the dependent values obtained at rest and after 10, 15 and 20 repetitions. Independent “t” test was used to determine the significance between groups.
Results: No significant differences (p>0.05) were found in SBP and DBP after 10 repetitions in group 1 and among HR and SBP after 10 and 15 repetitions in group 2. There was a significant difference (p<0.05) in RPP after 15 and 20 repetitions within and between the groups.
Conclusion: Increased repetitions of spinal extension exercises in prone lying bring more cardiovascular stress when compared to the same performed in the standing position among class 1 obese subjects.
Keywords: McKenzie spinal extension exercises, extension in lying, extension in standing, rate pressure product, blood pressure, heart rate.

Vidhi Shah, Annamma Varghese

DOI : 10.15621/ijphy/2016/v3i5/117455

Pages : 637-642

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Background: Excessive Thoracic Kyphosis (TK) and Forward Head Posture(FHP) become more apparent in aging adults from the accumulation of remodeling in response to habitual postures. Faulty posture of the shoulders, neck, and particularly the head may contribute to the onset and perpetuation of cervical pain dysfunction syndrome. Current literature suggests that an association exists between the head posture, thoracic kyphosis and cervical range of motion in individuals with cervical spine dysfunction. Since age as well as cervical spine dysfunction may affect the above parameters, the objective of our research was to study the association between these in adults with and without cervical spine dysfunction.
Methods: 50 adults with CSD and 50 adults without CSD were assessed for TK, FHP and Cervical range of motion (CROM) by flexicurve method Kipnotic Index (KI), measuring cranio-vertebral angle(CVA) using a lateral-view photograph(digitized) of the subject and using Universal Goniometer respectively.
Results: In both groups, there was increased KI (TK), lesser CVA i.e. FHP and reduced CROM when compared to normative values, however there was no statistical difference in KI and CVA between the two groups (p=0.53,0.75). Cervical extension and rotation ranges were significantly reduced in CSD adults (p=0.00,0.00,0.00). Correlation between CVA and CROM, KI and CROM and KI and CVA was not significant in adults with as well as without CSD (p=0.16-0.51,0.05-0.35,p=0.08-0.69,0.19-0.52,p=0.13,0.94 respectively).
Conclusion: Correlation between FHP and CROM,TK and CROM, FHP and TK in adults with and without CSD was not significant.
Keywords: FHP, KI, CROM, CSD, CVA, Flexicurve, Photographic method

Reeta, Umesh kumar, Vinot Kumar, Mehbob Alam, Deeba Islami, Wakash Lal, Rajesh Kumar, Aneeta Bai

DOI : 10.15621/ijphy/2016/v3i5/117456

Pages : 643-646

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Background: Trigeminal neuralgia (TN) is also known as prosoplasia it is also termed as a Suicidal disease or Fothergill disease. The neuropathic condition is characterized by recurrent episodes of facial pains which are triggered by touch, chewing and shaving. The pain initiates from the 5th cranial nerve which is known as trigeminal nerve. The objective of this study was to evaluate treatment protocol used by physiotherapist for trigeminal neuralgia patients.
Methods: It was cross-sectional descriptive study in which data was collected from certified physiotherapists working in private/ government hospitals for more than 1 year in Karachi. The sample size was 60 and Purposive random sampling technique was used. The data collection procedure was questionnaire based that was filled by physiotherapists.
Results: In this study 77% physiotherapist’s answered that physiotherapy is helpful in patients with T.N and, 23% said that it is not beneficial.13.3% patients reported that they were taking medicines other than steroid and analgesics like (carbamezipine, gabapentine), 50% were taking steroids, 33.3% were taking NSAIDs, and 3.3% were taking antibiotics. Regarding Modality prescribed by physiotherapists in Trigeminal Neuralgia 68% physiotherapists used TENS to treat the disease, 30% used electrical stimulation and
only 2% used ultrasound.
Conclusions: Physiotherapy treatment is effective in the patients of T.N. Awareness needs to be generated amongst general public concern in the role of physiotherapy relating to the disease. The symptoms of some patients are not eased by the medicines, they should move toward electrical stimulation.
Keywords: Trans cutaneous nerve, awareness, neuralgia, protocol, physiotherapy

K. Manuja, K.Madhavi

DOI : 10.15621/ijphy/2016/v3i5/117481

Pages : 647-652

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Background: To find out the influence of intermittent compression therapy using sphygmomanometer on pressure changes and walking ability on individuals affected with peripheral arterial diseases of lower limbs.
Methods: Total thirty patients’ age 30 to 70 years post peripheral arterial diseases individuals included for study. These patients were randomly allocated to intervention group (n=15), which underwent a 6- weeks training program & control group (n=15) that received standard care and unsupervised exercise protocol. Primary outcome was change in ABI levels as determined in before and after the intervention program. Secondary outcomes were intermittent claudicating distance and walking capacity as assessed by the walking impairment questionnaire.
Results: Paired sample t- test was used to analyze changes from before and after intervention program. There is a statistically significant (p=0.000) improvement in both experimental group and control group but when compared to control group, experimental group shows improvement in the mean values in all parameters.
Conclusion: In this study the Ankle Brachial Index (ABI), Intermittent Claudication Distance (ICD) and Walking Impairment Questionnaire (WIQ) improved significantly in experimental group than control group by applying the pneumatic compression therapy with the sphygmomanometer and graded walking exercise. Hence, the study recommends that intermittent pneumatic therapy along with graded exercise is most effective in improving Ankle Brachial Index (ABI), Intermittent Claudication Distance (ICD) and Walking capacity in PAD individuals.
Keywards: Peripheral arterial diseases, ankle brachial index, intermittent claudication distance, walking distance, walking impairment questioner, intermittent pneumatic compression therapy.