Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

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Objective: To investigate the prevalence of musculoskeletal pain & to analyse the risk factors at Work-Station in Bus drivers.

Design: Cross- sectional study.

Method: 60 bus drivers were interviewed. A questionnaire was formulated on the basis of job demand analysis & ergonomic evaluation. Questions included were based on age, musculoskeletal pain, workrelated ergonomic & psychosocial stressing factors, and general health habits like addictions, exercise.

Result: Data was analysed by Logistic regression module & ODD'S ratio were calculated. Out of the 60 bus drivers, 20% reported no pain. Prevalence of musculoskeletal pain was 80%, in that most affected area was Low back (70%), neck (55%), shoulder (47.5%), Knee pain (31%) & then wrist & heel pain. The highest risk factors for back & neck pain were long term exposure to vibration & uncomfortable seat position.

Conclusion: Work related ergonomic & psychosocial factors showed a significant association with musculoskeletal pain in Bus drivers.

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Materials and Methods: 60 subjects having knee osteoarthritis with iliotibial muscle tightness participated in the study. They were divided into 2 groups: Group A and Group B, of 30 subjects each. Group A was given-iliotibial band stretching in Ober's test position and Conventional physical therapy (Ultrasound + Exercises). Group B was given- Conventional physical therapy only. Both the groups received the treatment for a period of 5 days.

Results: Results showed a statistically significant improvement on inter group comparison in the pain scores (on VAS) for walking, medial mobility of patella and Q angle. (p<0.001)

Conclusion: Conventional physical therapy is effective in improving pain and functional activities but Iliotibial band stretching has an added effect on functional activity of walking.

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Purpose: The purpose of our study was to evaluate the effects of nebulization and breathing control (N+B combination) as against only breathing control(B) on airway obstruction [by measuring peak expiratory flow rate(PEFR), forced expiratory volume in 1st second(FEV1) and dyspnea [by measuring respiratory rate (RR) and rate of perceived exertion (RPE)] in asthmatic patients.

Method: In total, 60 patients were selected according to the inclusion and exclusion criteria. Written informed consent was taken from the patients and asthmatic patients were randomly allocated to two groups either N+B or only B. Parameters PEFR, FEV1, RR and RPE on Borg's modified 10 point category ratio scale were obtained before and after the treatment session. Data was analyzed using SPSS 15. For statistical significance, p value of

Results: There was a statistically significant improvement in PEFR, FEV1, RR and RPE in both the groups. However, there was no statistically significant difference in PEFR and FEV1 i.e. airway obstruction between the two groups. But, there was a statistically significant difference in RR and RPE i.e. dyspnea between the two groups, with breathing control showing greater improvement in dyspnea.

Conclusion: Thus, asthmatic patients not only could reverse their airway obstruction (PEFR, FEV1) with Breathing control but also improved in terms of dyspnea (RR, RPE) as compared for Nebulization and Breathing control group. Nebulization and Breathing control group though it showed statistical significant improvement in airway obstruction(PEFR,FEV1) than only Breathing control; but the overall energy expenditure and thermogenic effect of nebulization with salbutamol did not help reverse dyspnea(RR and RPE)to the effect the breathing control could to.

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Materials and method: Subjects were asked to perform sequences of hand movements in response to target lights in 2 conditions: a patterned sequence and a random sequence. They were not given explicit knowledge of 2 conditions. The SRT to perform both patterned and random sequence activity was measured and comparison was done between both groups. On second day SRT of patterned sequence activity was measured for both groups to test retention.

Results: The mean SRT for both groups showed statistically significant decrease with patterned sequence(mean difference-elderly:3.745, stroke:5.108) increase with random sequence (mean difference-elderly:2.792, stroke:3.592) and again decrease with reintroduction of patterned sequence(mean difference-elderly:1.762,stroke:2.423). There was statistically significant retention of implicit learning in both groups. Conclusion: Implicit Learning of Serial Response Time Task is preserved in post Stroke subjects since both the groups showed the similar trend of performance in all the blocks, however, speed of performance of post stroke subjects was slower than that of normal elderly subjects.

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Background: Slump test, a neurodynamic test was used to test the mechanical movement of the neurological tissues and to test their sensitivity to mechanical stress. Various studies have been conducted to test the responses to slump test in normal young healthy adults. There is paucity of literature on the use of slump test in overweight young adults. Therefore the current study aims at finding out if increased tissue interface due to increased tissue mass in overweight young adults had an effect on normal neural tissue mobility as compared to normal young adults.

Aims: To compare the effect of different sensitizing maneuvers on slump test between normal and overweight young adults. Objectives: To measure the active knee extension deficit angle pre and post addition of sensitizing maneuvers in normal and overweight young adults and compare them. Settings and design: One time comparative study carried out at tertiary care hospital, Mumbai.

Materials and Method: 200 young healthy adults within the age group of 20-40 years were randomly selected for the study, of which 100 had a normal B.M.I.i.e.18.5-24.9 and 100 had overweight B.M.I. i.e.25-29.9.The outcome measure used was the goniometric active knee extension deficit angle. The readings were taken in four positions namely cervical spine neutral with ankle neutral, cervical spine neutral with ankle dorsiflexion, cervical spine flexion with ankle neutral, cervical spine flexion with ankle dorsiflexion and compared on both sides.

Statistical analysis: Mann-Whitney'U' test was used to analyze the active knee extension deficit angle score between the normal and overweight groups in all four positions.

Results: The mean active knee extension deficit angle score between the normal and overweight groups in all four positions was statistically significant (p<0.0001).

Conclusion: From the study it can be concluded that the neural tissue extensibility was reduced in overweight young adults as compared to age matched normal young adults.However, in both the groups the active knee extension deficit angle was below 30 degrees which is considered clinically normal.

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Background: Load of cognitive task increases the demands on postural control and balance in stroke patients making patients more susceptible to falls. So assessing balance under dual task conditions become important aspect of rehabilitation of stroke patients.

Aims: To see the effect of cognitive task on balance in chronic stroke patients.

Settings and design: Prospective experimental study carried out at tertiary care hospital, Mumbai.

Materials and Methods: 30 Chronic stroke patients (>6 months duration) above 50 years of age were assessed for balance with modified Clinical Test of Sensory Integration of Balance (mCTSIB) scale with and without cognitive task of calculation. Outcome measure was the balance score under four different conditions of the scale with and without cognitive task.

Statistical analysis: Wilcoxson Signrank test and paired t- test were used to analyze the difference between the balance scores with and without cognitive task.

Results: Balance decreased significantly with cognitive tasks in all four conditions of the mCTSIB scale. Condition 1- EOFI: (20.4 +7.32 - 17.5 +9.099) (p <0.001). Condition 2-ECFI: (12.7+7.29 - 9.25+7.196) (p <0.001); condition 3- EOFO: (11+7.87 - 10+9.099) (p <0.001); condition 4- ECFO: (3.4+ 4.95 - 2.1+ 4.65) (p <0.001).

Conclusion: Balance decreases under different conditions with concurrent cognitive task in chronic stroke patients. Hence treatment under dual task conditions in different environments should be an integral part of balance rehabilitation in stroke patients.

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Backrground: 30-60% of patients with stroke have no arm function.Spasticity causes hyperactivity in those muscles that can lead to decreased activity of their antagonists. Thus biceps spasticity can cause reduced control of triceps amounting to reduced reach function which is usually an important therapeutic goal. Some studies have evaluated efficacy of electrical stimulation (ES) on spasticity.

Aims: Purpose of the trial was to assess effect of stimulation of triceps on forward reach distancein stroke patients.

Settings and Design: Prospective, analytical, experimental, randomized and open trial done in Physiotherapy OPD of a tertiary care hospital.

Methods and Material: 50 post stroke patients, in the age group of 30 to 60year withspasticity of shoulder, elbow, wrist and hand muscles of affected extremity up to grade 2 on Ashworth Scale and Brunnstrom sequential recovery stage 3 or 4; were assessed for modified Tardieu Scale(MTS), active elbow extension range at elbow(AROM) and forward reach distance(FRD). They were randomly assigned to either of the Conventional (CG) or Experimental Group (EG). CG received motor training only whereas the EG received motor training and ES to triceps on affected upper extremity. After 3 weeks they were evaluated again for the above outcomes. Statistical tests were non-parametric tests as the data obtained was not normally distributed, as analyzed using Shapiro-Wilk test for normality. Wilcoxon Sign rank test for comparing medians in all 3 outcome measures. Mann Whitney test was also used to compare percent mean differences in both groups for all 3 outcome measures.

Results: FRD, AROM and MTS improved after 3 weeks in CG with significance of p-value of 0.0122 each and in experimental group with significance of p-value of 0.0121 each. FRD showed insignificant change between groups with p-value of 0.207. The mean percent difference in MTS, AROM and FRD was 0.007, 0.007 and 0.977 respectively.

Conclusions: Electrical Stimulation when given to the triceps muscle as an adjunct to the motor training has shown additional improvement in reducing the biceps spasticity, improving AROM but not significantly improving the FRD.

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Back ground: This clinical trial was carried out to compare the effect of Unsupported upper limb endurance training (USULET) and Lower limb endurance training (LLET) in patients with chronic obstructive pulmonary disease (COPD).

Subjects: 40 patients with COPD.

Method: All subjects were randomly assigned to either Group1: USULET or Group2: LLET. Both groups were assessed for six minute walk test distance (6MWTD)&quality of life (by chronic respiratory disease questionnaire - CRDQ) at baseline&after 6 weeks of endurance training program, as the outcome measures.

Results: Intra group comparison showed a statistically significant difference in 6MWTD&CRDQ score before and after the training program in both the groups. LLET as compared to USULET showed statistically significant improvement in 6MWTD, emotional and mastery score of CRDQ. However the dyspnoea&fatigue score of CRDQ showed equal improvements in both the groups

Conclusion: Both the training modes caused significant improvement in functional capacity&Quality of life, but LLET caused statistically significant improvement as compared to USLLET in functional capacity&emotional&mastery score of CRDQ.

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The purpose of the study was to find the effect of triceps brachii vibration on proprioception, during motor performance of elbow joint. 150 healthy young participants within the age group of 18 - 26 years were selected. To confirm that the method of vibration alters proprioceptive sensation, testing the limb position matching during both passive and active movements, without and with vibration was carried out. Vibration was applied directly over the triceps brachii tendon and visual feedback was restricted for all participants. Ranges of motion for both elbow joints were documented. The data obtained was analyzed statistically and results were displayed graphically.

During the vibration trials, a significant difference was found in the scores obtained by the matching limb, in the passive driven condition and active matching condition. This finding confirms that a vibratory stimulus applied to the triceps brachii, during elbow flexion, induced a illusory response resulting in a movement perceived in the direction of elbow flexion.

Thus it can be concluded that, vibration given to a muscle tendon effectively produces kinaesthetic illusion of a movement.

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A prospective study wherein 30 chronic respiratory disease patients fulfilling the inclusion criterion were enrolled and 8 weeks of outpatient structured exercise program was designed,outcome measures 6MWD and CRDQ were assessed at 0, 2nd, 4th and 8th week .

The mean 6MWD increased from 392.80 to 518.24 at the end of program and difference was statistically significant on applying repeat measure ANNOVA(F value=42.030,p=0.00000000054) indicating improvement in exercise performance . All 3 components of CRDQ, except Mastery component showed statistically significant improvement suggestive of improved quality of life.

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Background: Postural control depends upon the ability to extract peripheral sensory inputs, integrating this information within the central nervous system (CNS), coordinate and execute an appropriate motor response. Age related changes in the ability to adjust to alteration in sensory information contribute to impaired postural stability. The purpose of this study was to investigate the effect of sensory-specific balance training on balance in elderly.

Aims: To study the effect of sensory-specific balance training on the balance in elderly.

Settings and design: Prospective longitudinal comparative study carried out at tertiary care hospital, Mumbai.

Materials and Methods: 60 healthy elders were randomly assigned balance training and fall prevention education group. Sensory specific balance training was given for period of 4 weeks. Participants were reassessed at end of 4 weeks. Outcome measures were modified: Clinical Test for Sensory Interaction on Balance, Fullerton advanced balance score, activities specific balance confidence scale and 1 RM.

Statistical analysis: Wilcoxson Signed rank test and Mann Whitney test were used to analyze the difference between the balance scores within group and intergroup

Results: Balance improved significantly in all four conditions of mCTSIB scale following sensory specific balance training(p<0.001) Improvements were seen in Fullerton Advanced Balance score(p<0.001) and Activities Specific Balance Confidence Scale score(p<0.001) but there was no improvement in 1 RM(p>0.001)

Conclusion: From the study it can be concluded that sensory-specific balance training can bring about a significant improvement in balance without any change in the muscle strength.

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Introduction: Comprehensive balance evaluation along with identification of significant risk factors ia an important step towards fall prevention in geriatric population.

Objective: To evaluate efficacy of two available scales to test balance in fallers and nonfallers in Indian geriatric population.

Methodology: After the ethics committee approval an informed consent was taken from the participants. 70 elderly people above 65 years participated in the study. Group A had fallers and Group B had non fallers(no history of falls.They were evaluated for Fast evaluation of mobility , balance and fear(FEMBAF) and Dynamic gait index (DGI)

Results: There was a significant difference of mean scores between fallers and nonfallers.(P<0.001)Fallers have more number of risk factors with fewer scores on both the scales.

Conclusion: Fast evaluation of mobility, balance and fear (FEMBAF) and Dynamic gait index (DGI) are effective in differentiating between fallers and non fallers.

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