Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

Abstract

Materials used: table, chair, cassette and record player, stop-watch, newspaper.

Methodology: 80 independently ambulatory subjects (age group 50-70yrs) were randomly selected and divided into 2 intervention groups of 40 each. Task was to stand on the preferred leg with arms by side and one legged balance time was measured. Two sessions (1st & 2nd) of the task, of 5 days each, were given to subjects at a periodic gap of 30 days. Baseline and final measurements of one legged balanced time were compared after a three days practice intervention period. Group I (n=40, 20 male s and 20 females) performed only physical practice in both sessions (1st & 2nd) and Group II, (n=40, 20 males and 20 females) performed only physical practice in 1st session and in 2nd session performed physical practice interspersed with mental practice. Mental Practice involved use of idealized visual and kinesthetic mental images provided to subjects through recorded tape.

Results: Percentage improvement in balance time in both sessions was compared and statistical analysis was done by paired 't' test and 'z' test. All groups showed improvement, but Group II showed the most improvement in 2nd session, of 33.01% in males and 31% in female's resp. ('p' < 0.001). Comparison of percent improvement between Group I and II, showed an increment of 10% in balance time of group II in its 2nd session('p' < 0.001,HS).Thus showing that balance time increased significantly with physical practice interspersed with mental practice.

Conclusion: Our study concludes that Mental Practice along with Physical Practice may hence be an important therapeutic tool to encourage rapid acquisition of a motor skill.

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Abstract

Subjects: 30 individuals with a residual Walking deficit within one year of a first or recurrent stroke consented to participate.

Interventions: The experimental intervention comprised 5 functional task designed to increase the strength of the lower extremities and enhance walking balance, speed and distance. Both the group received treatment 5 days a week for three weeks.

Main measures: Six-minute walk test (SMWT), 5-m walk, Berg Balance Scale, timed 'up and go'.

Results: At baseline, subjects in the experimental (n_/15) and control (n_/15) groups walked an average distance of 152 mtsThere was statistically significant increase in the distance covered by the experimental group median152 to 208 mts.There was statistically significant difference in speed in five mts walk test. The experimental group showed increase in the median from 0.55m/s to 0.71m/ s.Experimental group showed statistically significant reduction in the time taken to complete the timed Up & Go test. The median decreased to 21 from the pre intervention value of 26.

Conclusions: Study findings support that a task-orientated intervention enhances walking distance, balance and speed in the post stroke patients.

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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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Purpose of the Study: To evaluate depression, fatigue, intelligence in Parkinson patients and find if correlation exists between them and the disease severity.

Material and Methods: 30 patients with idiopathic Parkinson's disease (PD) on conservative treatment and who could answer various questionnaire by themselves were selected. Patients with any other neurological disorder or complications were excluded. Patients were assessed on the UPDRS, Hoen and Yahr scale and Schawb and England scale and then were asked questions from the Beck Depression Inventory (BDI) which gave a total score of depression. The patients were assessed for intelligence by the MMSE. The patients were then asked questions from the 'Fatigue Severity Scale'.

Results: Data were analysed by the statistical test of "Correlation coefficient" and results were obtained as follows: Positive correlation between depression and disease severity. Negative correlation between intelligence and disease severity, between depression and intelligence and fatigue and activities of daily living. 63.3% patients severely affected on BDE. 40% mild to moderately affected on MMSE.

Conclusion: There is a definite non motor / Psychological affection in idiopathic Parkinson's disease.

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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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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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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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