[International Journal of Physiotherapy 2017; 4(6) : 319-388] RSS



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Vadnagarwala Rasheeda, Ramachandran Sivakumar

DOI : 10.15621/ijphy/2017/v4i6/163917

Pages : 319-323

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Background: Swiss ball is used as a tool in stroke rehabilitation It is commonly used to improve postural control. Sitting on unstable surfaces can provoke lower extremity muscle contractions as a component of postural control. Effect of unstable surface sitting on lower extremity control and functions following stroke is not clear from available literature. Hence this study was planned to study the effect of Swiss ball training on sit to stand function, weight bearing through paretic lower limb and motor control of paretic limb in patients with hemiplegia.
Methods: First-time stroke patients with hemiplegia were recruited from an acute stroke care set up in a University teaching hospital and assigned to control (n=34) and experimental group (n = 33). Along with physiotherapy based on impairments, patients in control group were trained for sitting to standing and sitting activities on a stool, and from in the experimental group were trained with Swiss Ball. Both the groups underwent 40 minutes of training for ten days. 30-second sit to stand, Percentage of weight bearing through the paretic limb and Brunnstrom stages were recorded. Parametric and non-parametric tests were used based on the outcome tested.
Results: The baseline characteristics between the groups were similar statistically. Post-intervention experimental group had better weight bearing ability and motor control of lower limb (p<0.05), than the control group. The difference in 30-second sit to stand did not reach statistical significance (p=0.059).
Conclusion: Training with Swiss ball results in greater improvement in weight - bearing ability and motor control of paretic lower limb, compared to conventional training. The Swiss ball training does not enhance the sit to stand performance more than conventional training.
Keyword: Hemiplegia, sit to stand, Swiss ball, Rehabilitation, Brunnstrom stages.

Mohansundar Sankaravel

DOI : 10.15621/ijphy/2017/v4i6/163918

Pages : 324-326

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The researchers and authors are publishing their work in the scientific journals for accomplishment and acknowledgement for what they have achieved in their field of study. As an effect of digitalization now a day many journals are readily available in the World Wide Web for good. At the same time, anecdote of misconduct, negligence and deception of the publishers are also getting higher and higher in this regard. Thus, choosing a trustworthy journal is important for every researcher especially young researchers to avoid potential damage to any one of the purposes of publishing an article.Since many factors are influencing to choose a right and trustworthy journal for manuscript submission and at the same time is more critical for any of the young researchers and authors as well. Hence, this short communication as preamble;emphasizing on the factors such as the visibility of a journal, manuscript processing procedures, the governance and the impact factor will possibly be a prelude for the young researchers and authors those who are all trying to submit a manuscript and get it published their research work in trustworthy journals to achieve any of purposes of publishing.

Konstantinos Zemadanis, Theodoros Betsos

DOI : 10.15621/ijphy/2017/v4i6/163919

Pages : 327-334

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Background: It is well known that Iliotibial band syndrome (ITBS) is the most frequent overuse injury in recreational runners. Given the fact that there are no clear guidelines on the optimal conservative treatment approach regarding ITBS rehabilitation, manual therapy effect by a functional joint mobilization is still unknown. The purpose of the study was to investigate whether implementation of mobilization-with-movement (MWM) and auto-mobilization had a significant short-term improvement in pain and functionality of recreational runners with ITBS.
Methods: Participants: thirty ITBS patients, were randomly assigned into two groups. Design and Settings: One group pre-test /post-test with the control group. Interventions: Runners on the treatment group followed an MWM protocol of six sessions with an additive program of auto-MWM, while the control group received a SHAM form of MWM. Outcome measurements: Pain and functionality were measured at baseline and post-treatment, via Numeric Pain Rating scale and Lower Extremity Functional Scale respectively. Mixed-ANOVA test detected possible differences among treatment phases and between groups, but also interactions among factors.
Result: The present findings revealed significant interactions between factors and significant main effects of each TIME and GROUP factors on pain and functionality. MWM-treatment group showed significant improvement in post-intervention NPRT and LEFS scores, compared to baseline scores (p<.001). SHAM-MWM group exhibited no significant differences on post-NPRT and LEFS scores, compared to baseline (p>.001). Differences between groups were significant in post-treatment scores (p<.001).
Conclusion: Our findings suggest that MWM and auto-MWM are a significant treatment approach, improving pain and functionality in recreational runners suffering from ITBS.
Keywords: iliotibial-band-syndrome, mobilization-with-movement, runners, manual therapy.

Ashraf Darwesh, Moussa A. Sharaf, Ahmed M. Aboeleneen

DOI : 10.15621/ijphy/2017/v4i6/163920

Pages : 335-342

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Background: Polyneuropathy is one of the most common chronic complications associated with diabetes mellitus, it is a damage to the peripheral nerves and manifested by signs and symptoms as numbness, irritation, and pain in the upper and lower limbs. This study aimed to evaluate muscular performance and proprioception at the ankle in diabetic neuropathic patients with quantitative and standardized tools and correlate these findings with those of sural nerve conduction velocity (sural NCV) and amplitude.
Methods: Fifteen male patients with diabetic neuropathy participated in this study, with age ranged from 40 to 55 years, and fifteen age-matched healthy subjects participated as a control group. Biodex Isokinetic System was used to assess the strength of ankle dorsiflexors and planter flexors and ankle reposition accuracy. Berg balance test was used to assess balance. Sural nerve conduction velocity (NCV) and amplitude were examined by diabetic polyneuropathy check (DPN-check) device.
Results: The results showed a significant decrease in the mean peak torque values of the plantar flexors and dorsiflexors and a significant increase in the reposition error in the diabetic neuropathic group (p=0.0001). The results also revealed a significant decrease in the mean values of the Berg balance scores in diabetic neuropathy group (p=0.0001). Sural NCV and amplitude tests revealed abnormal values (p<0.05).
Conclusion: It was concluded that the isokinetic system is an objective and sensitive tool to detect the motor and sensory changes of the diabetic neuropathic patients, also an examination by DPN-check device help in the determination of the severity of the disease. Moreover, it can be concluded that there are strong correlations between duration of diabetes and sural nerve NCV and amplitude and the peak torque of the muscles around the ankle.
Keywords: Isokinetic, Polyneuropathy, Diabetic neuropathy, Nerve conduction velocity, Proprioception, Reposition accuracy.

Masahiro Edo, Sumiko Yamamoto, Toshikazu Yonezawa

DOI : 10.15621/ijphy/2017/v4i6/163921

Pages : 343-347

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Background: It’s important to understand the kinematic coupling of calcaneus and shank to optimize the pathological movement of the lower extremity. However, the quantitative indicator to show the kinematic coupling hasn’t been clarified. We measured the angles of calcaneal pronation-to-supination and shank rotation during pronation and supination of both feet in standing position and devised a technique to quantify the kinematic coupling behavior of calcaneal pronation/supination and shank rotation as the linear regression coefficient (kinematic chain ratio: KCR) of those measurements. Therefore, we verified the validity and reproducibility of this technique.
Methods: This study is a non-comparative cross-sectional study. The KCR, which is an outcome, was measured using an optical three-dimensional motion analysis system in 10 healthy subjects. The coefficient of determination (R²) was calculated for the linear regression equation of the angle of calcaneal pronation-to-supination and angle of shank rotation, and the intraclass correlation coefficient (ICC [1,1]) was calculated for the KCR during foot pronation and foot supination and for the KCR measured on different days. And also, skin movement artifacts were investigated by measurement of the displacement of bone and body surface markers in one healthy subject.
Results: The linear regression equation of calcaneal pronation/supination and the angle of shank rotation included R²≥0.9 for all subjects. The KCR on foot pronation and supination had an ICC(1,1) of 0.95. The KCR measured on different days had an ICC(1,1) of 0.72. Skin movement artifacts were within the allowable range.
Conclusion: The validity and reproducibility of this technique were largely good, and the technique can be used to quantify kinematic coupling behavior.
Keywords: kinematic chain, calcaneus, shank, validity, reproducibility, motion analysis.

Negin Khoshvaght, Ghorban Hemati Alamdarloo, Diba Seif

DOI : 10.15621/ijphy/2017/v4i6/163922

Pages : 348-357

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Background: Cerebral palsy is a nonprogressive neuro-developmental disorders that are caused by damage to the developing brain and affect movement and posture. Children with cerebral palsy suffer difficulty in motor function (coordination and control).The present inquiry investigated the impact of conductive education on motor skills in children having cerebral palsy.
Methods: A quasi-experimental research was done using pretest-posttest and control group design. The study subjects consisted of all children with cerebral palsy in Shiraz. A sample of 30 subjects was randomly chosen to employ convenience sampling procedure and classified to two groups of treatment (15 subjects) and control (15 subjects). The pretest was performed for both groups, and the experimental group received conductive education in 20 sessions. While the control subjects did not have this education, finally, the post-test was performed for both groups. The Lincoln-Oseretsky test was used to measure motor skills. The data were analyzed using ANCOVA and MANCOVA.
Results: The results showed that conductive education had a significant effect on motor skills (P<0.001) and its subscales such as speed of movement (P<0.001), general static coordination (P<0.001), general dynamic coordination (P<0.001), dynamic manual coordination (P<0.001), synchronous-asymmetrical voluntary movements (P<0.001), and asynchronous-asymmetrical voluntary movements (P<0.001) in children with cerebral palsy.
Conclusion: The findings indicated the effectiveness of conductive education on cerebral palsy children’s motor skills. Therefore, it is recommended to design and implement a conductive education program to improve motor skills of cerebral palsy children.
Keywords: Conductive Education, Motor Skills, Children, Cerebral Palsy.

Karthikeyan Selvaganapathy, Roshini Rajappan, Chandra Malani Balachanthran

DOI : 10.15621/ijphy/2017/v4i6/163923

Pages : 358-362

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Background: The most important trunk stabilizers are the trunk flexors and extensors. The isometric endurance of the trunk muscles is an essential element for mechanical support of the spine in all positions. The study objectives were to find out the trunk flexors and extensors endurance, its relationship with normal BMI and to find out the ratio of trunk flexors to extensors endurance.
Methods: In this correlation study, 50 subjects were selected by convenience sampling method on the basis of inclusion and exclusion criteria from Asia metropolitan university, Malaysia. The trunk flexors and extensors endurance were assessed by Kraus- Weber and Sorenson test respectively. Paired 't' test and Spearman correlation test were used for data analysis.
Results: There was a significant difference (p< 0.05) between trunk flexors (65.4± 26.5) and extensors (107.8±41.7) endurance. Trunk extensors endurance was higher than trunk flexors endurance. A two-tailed test of significance indicated that BMI was unrelated to the subject’s TFE, rs (50) = -0.160, p > 0.01 and TEE, rs (50) = -0.162, p >0.01 but there was a significant strong positive relationship between TFE and TEE, rs (50) = 0.68, p < 0.01. The ratio of trunk flexors to extensors was 0.61.
Conclusion: The trunk extensors endurance is higher than trunk flexors endurance and BMI has no relationship with trunk flexors and extensors muscle endurance. The ratio of trunk flexors to extensors endurance value is low.
Keywords: Body Mass Index (BMI), Trunk Flexors Endurance (TFE), Trunk Extensors Endurance (TEE), Kraus- Weber test, Sorenson test.

Suchetha P. S, Dhanesh Kumar K. U, Mallikarjunaiah H. S

DOI : 10.15621/ijphy/2017/v4i6/163924

Pages : 363-367

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Background: Spasticity is the common problem encountered in the treatment of hemiplegic patients. Various treatment techniques have been developed to reduce spasticity, neuromuscular electrical stimulation is one of them. Several studies have proved that stimulation of either spastic muscle or stimulation of antagonist muscle to spastic muscle results in a reduction of spasticity. However, there is no literature available on a comparative study to suggest which method is more effective in spasticity reduction. Hence this study was undertaken to find out the efficacy of each technique and to compare the two techniques of Neuromuscular electrical stimulation to determine the most effective technique.
Methods: In this study with pre and post-experimental design 30 post-stroke patients were selected and they were randomly assigned into two groups. Group A received anatagonist (triceps) muscle Neuromuscular electrical stimulation and Group B received agonist (biceps brachii) muscle Neuromuscular electrical stimulation for 2 weeks, one session per day for a duration of 30 minutes. Outcome measures were recorded using modified Ashworth scale and deep tendon reflex grading scale.
Results: Statistical analysis was carried out by using Wilcoxon signed rank sum test and Mann-Whitney U test at 0.05 level of significance. There was a significant recovery after the treatment based on the Modified Ashworth Scale and deep tendon reflex grading scale scores before and after the intervention within the groups and between the groups with p-value< 0.001. The group receiving the antagonist muscle neuromuscular electrical stimulation showed better recovery with a mean difference of 1.8 and 1.2 on Modified Ashworth Scale and reflex grading scale respectively.
Conclusion: The study concluded that both the techniques resulted in reduction of spasticity and on comparison it was found that antagonist muscle (triceps) Neuromuscular electrical stimulation reduced spasticity more effectively than the agonist muscleNeuromuscular electrical stimulation
Keywords: Stroke; spasticity; NMES; antagonist muscle; agonist muscle; MAS.

Maria de Fatima Guerreiro Godoy, Renata Lopes Pinto, Stelamarys Barufi, Jose Maria Pereira de Godoy

DOI : 10.15621/ijphy/2017/v4i6/163925

Pages : 368-370

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Introduction: Pain associated with lymphedema is common, but it is rarely a limiting factor. The aim of the present study is to report the effect of five days of intensive treatment of a patient with sequelae of poliomyelitis associated to an infection that progressed to lymphedema and six months of intense pain.
Case summary: A 65-year-old patient with sequelae of poliomyelitis from the first year of life evolved with infectious processes and lymphedema after several surgeries for fractures. The patient suffered constant limiting pain for six months. The lymphedema was confirmed by bioimpedance after she sought treatment. The patient was submitted to intensive treatment eight hours/day for five consecutive days using Mechanical Lymphatic Therapy (RA Godoy©).
Outcome Measures: After the first day of treatment the pain was reduced to moderate intensity, after the second day, ankle movement improved facilitating ambulation and after the third day, she felt no more pain. The patient is continuing with maintenance therapy using the RA Godoy© device for one hour/day at home.
Conclusion: Limiting pain is uncommon in lymphedema but in this case, it was associated with repetitive infectious events. The pain disappeared with Mechanical Lymphatic Therapy.
Keywords: Lymphedema, Physical Disability, Poliomyelitis, Pain, Mechanical Lymphatic Therapy (RAGodoy ©), Treatment.

Abdullah M. Al-Shenqiti

DOI : 10.15621/ijphy/2017/v4i6/163926

Pages : 371-376

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Background: Many therapeutic uses for Pulsed magnetic fields have been extensively studied. Beneficial effects on the musculoskeletal system were established including bone healing, pain relief, and inflammatory conditions. The study aimed at investigating the possible effects of the pulsed magnetic field on quadriceps muscle torque, hamstring muscle torque and knee proprioception accuracy in athletic subjects.
Methods: A randomized controlled trial which was carried out at the Faculty of Medical Rehabilitation Sciences, Taibah University, Saudi Arabia. Thirty healthy male athletic subjects, aging from 18 – 24 years were divided into two groups, study group (15 subjects) & control group (15 subjects). The pulsed magnetic field was applied for subjects of intervention group, while control group participants received sham pulsed magnetic field for 12 sessions over a period of 4 weeks. Quadriceps muscle torque, hamstring muscle torque & knee proprioception accuracy were measured before & after treatment for all participants using Biodex system 4 pro isokinetic dynamometer.
Results: Multiway ANOVA was carried out to detect any significant differences within and between groups. Statistically significant differences between study and control groups were found after pulsed magnetic field application in quadriceps peak torque (at 60 and 120deg/sec) & hamstring peak torque (at 60 and 120deg/sec) and in knee proprioception accuracy (p-value was 0.004, 0.0001, 0.02, 0.03, 0.0001 respectively).
Conclusion: Pulsed magnetic field has beneficial effects on quadriceps muscle peak torque, hamstring muscle peak torque and knee proprioception accuracy in healthy athletic subjects and can be advised as an adjunctive tool in rehabilitation programs.
Keywords: Pulsed Magnetic Field, Muscle Torque, Knee Proprioception Accuracy.

Luxwell Jokonya, Aaron Musara

DOI : 10.15621/ijphy/2017/v4i6/163927

Pages : 377-381

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Introduction: Neuromodulation in its various forms is emerging as a promising method of dealing with chronic pain and movement disorders. The scale of ablative vs augmentative procedures seems to be tilting towards augmentative procedures. We observed 8 patients who had failed medical treatment for muscle spasm respond to the cold application.
Case summary: We report 2 cases of complete traumatic spinal cord injury patients, who developed severe, medically intractable muscle spasms. We applied cryotherapy to their legs with significant improvement.
Outcome measurements: The spasm frequency score dropped immediately from a 4 to 0 in one patient. The other dropped from a 2 to 1 on day one then disappeared by day 7. Spasm severity dropped significantly on the first day in both cases.
Conclusion: Cryotherapy as a form of neuromodulation, Is an effective, simple but safe way to symptomatically manage severe medically refractory muscle spasms in spinal cord injured patients. It becomes an important adjunct in the management of these patients in resource-limited settings where surgical options are not readily available.
Keywords: cold therapy, cryotherapy, spasms, spasticity, neuromodulation, and spinal injury.

Ejazi G, Hamdani N, Kumar S

DOI : 10.15621/ijphy/2017/v4i6/163928

Pages : 382-388

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Background: To evaluate the test-retest reliability of Jamar hand held dynamometer for measuring handgrip strength (HGS) in patients with acute and chronic cervical radiculopathy and to find out the difference in measurement of the handgrip strength between acute and chronic cervical radiculopathy.
Methods: A prospective, observational and non-experimental, the comparative study design was used. A sample of 72 subjects (37 women and 35 men) suffering from cervical radiculopathy were divided into two groups i.e., Group A(acute) and Group B(chronic), handgrip strength was measured using Jamar hand held dynamometer on two occasions by the same rater with an interval of 7-days. Data collection was based on standard guidelines of American Society of Hand Therapists. Three gripping trials (measured in Kg) with patient’s arm in standardized arm position were recorded. The data was analyzed from the mean score obtained from the sample.
Result: One-way Analysis of Variance(ANOVA) was used to evaluate test-retest reliability and Tukey-Kramer Multiple Comparison Test used to find the difference between handgrip strength among acute and chronic Cervical radiculopathy cases. Greater P-value (>0.05) in both testing session, as well as 95% of the confidence interval, shows the reliability of the instrument and lesser p-value (<0.05) in male subject shows a significant difference in handgrip strength and greater p-value (>0.05) in female subjects shows no significant difference in handgrip strength between the two groups.
Conclusion: Excellent test-retest reliability for hand grip strength measurement was measured in patients with acute and chronic cervical radiculopathy shows that the equipment could be used as an assessment tool for this patient and significant difference exists among male handgrip strength between acute and chronic cervical radiculopathy cases whereas no difference exists among female handgrip strength between acute and chronic cervical radiculopathy cases.
Keywords: reliability, Handgrip strength, jamar hand dynamometer, acute and chronic cervical radiculopathy.