பிசியோதெரபி & உடல் மறுவாழ்வு இதழ்

Early diagnosis of Alzheimer’s disease (AD) is very difficult. The main characteristic of neuro-image in AD is the atrophy of hippocampus and the main symptoms of AD is memory disturbance. However, we speculate these two sticks cause overdiagnosis or underdiagnoses of AD because the atrophy of hippocampus is not specific to AD and memory disturbance is not the first symptom in AD. As for memory disturbance, this symptom is not only unspecific to AD but also not the first symptom in AD. Moreover, we speculate that there two situations when the pathological symptoms occur at MCI in AD.On situation is when patients with AD at the MCI stage relax, at which time these patients show apathy. The other situation is when they are more stressed than usual. In this situation, these patients will be upset or panic. Therefore, the most important is hearing family of caregiver whether the patient shows apathy when he or she is relax (e.g., when they watch television, they fall asleep) and whether he or she is confused or panic when he or she is more stressed than usual.

Background: Eccentric training redresses the consequences of spastic muscle shortening by altering the length– tension characteristics of muscle to operate at longer lengths

Purpose: Purpose of this study was to study the effect of eccentric control training on balance and gross motor function in children with Spastic Cerebral Palsy.

Methods: The study was prospective controlled study, simple randomization plane used to assign participants, triple blind study (participant, outcomes assessor, data analysts). 40 children with spastic cerebral palsy were enrolled from the pediatrics' out-patient clinic, faculty of physical therapy, Cairo University.

Participants randomly divided into experimental and control groups. The experimental group received 60 minute of neurodevelopmental technique and eccentric control exercise. While, 60 minute of neurodevelopmental technique was applied for the control group. Stability index of The Biodex balance system (primary measure) as well as standing and gait parameters of the gross motor function measures (secondary measure) were evaluated before and after the trail.

Results: There was a significant difference between the control and the study group in the overall stability indices in favour of the study group (P<0.001) with confidence interval 95%. Significant increase in the values of GMFM post treatment of study group compared with the control group (p<0.02).

Conclusion: Eccentric control exercise therapy in children with spastic Cerebral Palsy is an effective approach to develop balance and gross motor function.

Objective: To determine the effect of trunk extensor muscle fatigue on postural stability in healthy young adults using clinical measures Design: Prospective, experimental, within subject, repeated measures design Setting: Tertiary care hospital and research centre Participants: 70 healthy adults in the age group of 20 to 25 years, volunteer sample Intervention: Fatigue of trunk extensor muscles was induced by repeated dynamic contractions performed to maximum exhaustion. Postural stability was assessed under three different conditions viz. No fatigue, Fatigue and Recovery. Main Outcome Measures: One-leg standing balance test and Functional reach test were used to assess static and dynamic postural stability respectively. Results: Wilcoxon matched-paired signed ranked test was used for comparison of postural stability in No fatigue and Fatigue condition with p-value<0.001. One-leg standing balance test showed a significant decrease from No fatigue (15.16+8.47 seconds) to Fatigue (5.89+5.7 seconds) condition. Functional reach test values showed a significant decrease from No fatigue condition (12.34+2.61 inches) to fatigue condition (12.27+2.6 inches). Mean recovery time was 12.5+3.27 minutes for One-leg standing balance test and 11.93+3.22 minutes for the Functional reach test. Further analysis using Mann Whitney test showed no significant difference (P=0.288) between the recovery time of one-leg standing balance test and functional reach test. Conclusions: Trunk extensor fatigue significantly affects static and dynamic postural stability in healthy young adults. Complete recovery takes 12.5+3.27 minutes for static and 11.93+3.22 minutes for dynamic postural stability. Results of this study stress the importance of intact trunk extensor muscle function on the regulation of static and dynamic postural stability in healthy young adults. However, more studies are required to determine the effect of trunk extensor muscle fatigue using other clinical measures and in individuals with neuromuscular disorders.

Background: It has been reported that 40% of new patients referred to orthopaedic clinics had radiographs in the previous 12 months. This means that radiographs very often have to be obtained during clinics, thus increasing outpatient clinic waiting time. This is especially so in District General Hospitals (DGHs) where long out-patient clinic waiting times cause dissatisfaction among patients.

Purpose: To determine whether new patients to orthopaedic clinics were being referred with plain film radiographs.

Design and setting: Retrospective study over a one month period in a DGH and a Tertiary referral centre.

Method: All new patient referrals to two consultant surgeons in a DGH and to four consultants in a Tertiary referral centre were reviewed over a one-month period to identify whether radiographs had been performed prior to referral. Information on previous radiographs was obtained from GP referral letters, orthopaedic clinic letters and this was verified through the imaging system at the hospitals.

Results: There were 414 patients seen in the two hospitals in the study period, of which 102 were new GP referrals. 37.3% of these new patients were referred with no plain-film radiographs.

Conclusion: More than a third of new patient GP referrals to orthopaedic clinics were not accompanied by plainfilm radiographs. The efficiency of clinics and patient satisfaction is likely to be improved if this is addressed.

Motor symptoms in Parkinson's disease from the early stages of the disease affect balance and mobility. Functional disorders caused by clinical symptoms lead to deterioration in activities of daily living and quality of life, depending on the severity of disease. The physiotherapy program to be applied according to the needs of the patient in different phases of Parkinson's disease will also vary. Beginning the physiotherapy program in early stages of disease may help to avoid problems that lead to dependence, inactivity, social isolation and reduced quality of life. Rehabilitation starting in the early postoperative period prolongs the effectiveness of deep brain stimulation. Physiotherapy improves both activities of daily living and the quality of life as well as motor symptoms after surgery.

Background: Severe lower extremity injuries require limb salvage, amputation and/or late amputation. Our purpose was to compare gait mechanics pre-amputation without a brace, pre-amputation with a brace and postamputation with prosthesis.

Case descriptions and methods: Three subjects with severe lower extremity injuries underwent limb salvage and late transtibial amputation. Biomechanical gait assessment was performed without a brace, with a brace and after amputation with prosthesis.

Results: Case 1, peak dorsiflexion angle was 94% higher post-amputation compared to bracing and peak ankle torque and power were similar with bracing and post amputation. Case 2, the ankle torque was increased when testing with bracing, but there was no difference between bracing and post-amputation. Ankle power was 78% higher post-amputation. Case 3, the ankle power was 16% higher post-amputation compared to bracing.

Conclusion: In patients pursuing limb salvage where the limb is braceable, it functions similar to a transtibial amputation with prosthesis.

Objective: To describe prevalence of scapular dyskinesis (SD) in adult patients with distal radius fractures (DRF).

Material and methods: The current cross-sectional study was conducted at the San Borja Arriaran Clinical Hospital. 180 patients with a type an extra-articular DRF, according to the AO classification, were recruited. The presence of SD was evaluated with the yes/no dynamic test based on visual criteria, and the clinical diagnosis of shoulder pain was performed by orthopedic surgeon.

Results: The prevalence of SD is shown in 80% of all patients with DRF, this value increases to 90.9% in group of patients with associated shoulder pain. The odds ratio was 10 with a 95% CI: 4.1-24.8 (p=0.0000).

Conclusions: The prevalence of SD is shown in 80% of all patients with DRF; this value increases to 90.9% in the group of patients that present DRF with associated SP. The ratio for estimating prevalence is 10 times higher in patients with DRF with shoulder pain compared with the asymptomatics shoulders. There is a statistically significant association between the presence of SD and shoulder pain in patients with DRF.

Background: Falls are major source of death and injury in elderly population. Physiological age related changes in somatosensory, vestibular and visual systems are well documented in older adults. These changes coupled with age related changes in muscle and bones to contribute to an increased risk of falls.

The prevalence of fear of falling in community-living elderly ranges between 12% and 65%, and is higher in women than men, commonly occurs after falls, but also occurs without a previous history of fall.

Aim and objectives: To study and determine the effectiveness of sensory motor training program in community dwelling elderly individuals with history of fall.

Methodology: Sixty community dwelling elderly individuals were selected from geriatric home care, and study group were form by using purposive sampling. The group under gone sensory motor training program and evaluated on the basis of Berg Balance Scale (BBS), Modified Fall Efficacy Scale (MFES) and Quality of Life (QoL). Intervention used to improve balance consisting of a 45 min. to 1-hour session three times a week.

Results: Total 58.33% of patients show, one fall in previous year while 41.67% of patients show two falls in previous year. The mean of BBS at baseline was 39.95 ± 6.32, the mean of BBS at 3 months was 46.21 ± 4.66 and the mean of BBS at 6 months was 43.63 ± 5.10, which is statistically significant (p<0.0001). The mean of MFES at baseline was 4.92 ± 0.39, the mean of MFES at 3 months was 5.71 ± 0.53 and the mean of MFES at 6 months was 5.34 ± 0.51, which is statistically significant (P>0.0001). And finally, for the mean of QoL at baseline was 3.61 ± 0.46, the mean of QoL at 3 month was 4.36 ± 0.42 and the mean of QoL at 6 month was 4.06 ± 0.40, which is statistically significant (p>0.0001).

Conclusion: Effect of sensory motor training program shown improvement in balance, reduction in fear of fall, improves quality of life and also helps to prevent fall in community dwelling elderly individuals with history of fall.

Objective: Cardiac cachexia is a condition associated with heart failure, particularly in the elderly, and is characterized by loss of muscle mass with or without the loss of fat mass. Approximately 15% of elderly heart failure patients will eventually develop cardiac cachexia; such a diagnosis is closely associated with high morbidity and increased mortality. While the mechanism(s) involved in the progression of cardiac cachexia is incompletely established, certain factors appear to be contributory. Dietary deficiencies, impaired bowel perfusion, and metabolic dysfunction all contribute to reduced muscle mass, increased muscle wasting, increased protein degradation, and reduced protein synthesis. Thus slowing or preventing the progression of cardiac cachexia relies heavily on dietary and exercise-based interventions in addition to standard heart failure treatments and medications.

Methods: The aim of the present study was to test the feasibility of an at-home exercise and nutrition intervention program in a population of elderly with heart failure, in an effort to determine whether dietary protein supplementation and increased physical activity may slow the progression, or prevent the onset, of cardiac cachexia. Frail elderly patients over the age of 55 with symptoms of heart failure from UAMS were enrolled in one of two groups, intervention or control. To assess the effect of protein supplementation and exercise on the development of cardiac cachexia, data on various measures of muscle quality, cardiovascular health, mental status, and quality of life were collected and analyzed from the two groups at the beginning and end of the study period.

Results: More than 50% of those who were initially enrolled actually completed the 6-month study. While both groups showed some improvement in their study measures, the protein and exercise group showed a greater tendency to improve than the control group by the end of the six months.

Conclusion: These findings suggest that with a larger cohort, this intervention may show significant positive effects for elderly patients who are at risk of developing cardiac cachexia.

Introduction: Sexual life is an important component of the quality of life. However, it is frequently neglected aspect in patients with hip osteoarthritis. The aims of the study were to evaluate the influence of the total hip replacement (THR) surgery on the quality of sexual life (QSL). Methods: a retrospective study using an anonymous questionnaire administered to 270 patients in a face-to-face interview at physical medicine and rehabilitation department. Results: The mean age when sexual difficulties began was 45 years (range: 21-63) two years after hip pain occurred. Sexual difficulties were considered severe to major by 19% of patients. The main causes of sexual difficulties were pain, then joint stiffness. Patients with the most pronounced and early sexual repercussions were young women with hip dysplasia. In patient’s opinion, the implementation of THR improves sexual relations. The frequency of intercourse was increased after THR significantly more frequently in women than in men, due to a change in coital position. Only 17% of patients had information about sexual activity before/after THR. Conclusion: Sexual difficulties should not be marginalized, but should be assessed before and after surgery. It is the role of a multidisciplinary team: surgeon, physiatrist and physiotherapist as they should provide clear information.