Active Range Of Motion Exercises Research Articles

Manual Therapy Versus Exercise Therapy in Patients with Osteoarthritis of Knee -A Comparative Study

AIM OF THE STUDY: The aim of the study to compare the effectiveness of manual therapy versus exercise therapy in patients with knee osteoarthritis in terms of decreasing pain HYPOTHESIS • Null Hypothesis: There may be no significant difference in the effectiveness of manual therapy and exercise therapy in patients with knee osteoarthritis • Alternate Hypothesis: There may be significant difference in the effectiveness of manual therapy and exercise therapy in patients with knee osteoarthritis INTERVENTION Group A: MANUAL THERAPY Manual physiotherapy protocol consisted of Treatment is done for two sessions per week for four weeks. Knee Mandatory interventions: 1. Knee flexion, non-thrust Antero-posterior directed force to the tibia, 2. Tibio-femoral joint ,non-thrust 3. Knee extension, non-thrust Postero-anterior directed force to the tibia 4. Tibio-femoral joint, non-thrust 5. Patellar gliding force, non-thrust 6. Manual stretch to quadriceps, hamstring, triceps surae muscle groups 7. Soft tissue manipulation ,quadriceps and Peripatellar connective tissue, hamstring, hip adductor and triceps surae muscles groups Treatment is done for two sessions per week for four weeks. Group B: EXERCISE THERAPY This group performed a closely supervised standardized knee exercise program at twice a week for four weeks at eight treatment sessions. This program consists of active range of motion exercise for knee, muscle strengthening exercise for hip and knee, muscle stretching for lower limbs and riding a stationary bike. Aerobic exercises • Up to 10 minutes stationary bicycle or walk. Stretching exercises: • Standing calf stretch – 3 repetitions with 30 sec hold • Supine hamstring stretch -3 repetitions with 30 sec hold • Prone quadriceps stretch –3 repetitions with 30 sec hold Range of motion exercises: • In long sitting position, • Knee mid flexion to end range extension – two 30 sec bouts with 3 sec hold at end range • In long sitting position, knee mid flexion to end range flexion – two sec bouts with 3 sec hold at end range Strengthening exercises: • Static quad sets in knee extension –one set of 10 repetitions with 6 sec hold,10 sec rest between repetitions. • Short arc terminal extension exercises for the knee joint. • Quadriceps non-weight bearing progressive resistance exercises with weighted cuffs. • Supine Straight Leg Rise (SLR) Neuro muscular control exercises: Closed chain progression: • Seated leg press – one 30 sec bout • Standing weight –shifting exercises • Side- stepping • Step ups • Forward-backward and shuttle – walking drills RESULTS: Knee function of all patients increased significantly after the 4-week intervention program in both the groups of MANUAL THERAPY and EXERCISE THERAPY but Group A Manual therapy improved more significantly when compared to Group B Exercise therapy. CONCLUSION: Treatment effect was more in the patients received Manual therapy when compared to Exercise therapy. This finding suggest that Manual therapy can be useful intervention supplement in patients with osteoarthritis of knee.

Physiotherapy for Alzheimer’s Disease: A Case Report

Alzheimer's disease is a progressive neurological condition characterized by brain changes resulting in the accumulation of specific proteins, leading to brain shrinkage and eventual cell death. It is the primary cause of dementia, resulting in a gradual decline in memory, cognition, behaviour, and social skills, impairing overall functionality. The case study involves an 84-year-old woman displaying symptoms of Alzheimer's disease requiring physiotherapy rehabilitation. Assessment reveals joint pain, abnormal gait, respiratory issues due to pneumonia, reduced balance and cognitive function, concentration difficulties, impaired decision-making, fluctuating moods, and behavioural issues such as depression and aggression. Physical examination shows shoulder shrugging and slight tension in the upper trapezius muscle. The rehabilitation program involves various interventions like stretching, strengthening, aerobic exercises, breathing exercises, lung clearance techniques, active range of motion exercises, postural control, and gait training. The role of the physiotherapist is to address the both physical and cognitive decline and improve mood and behaviour.

The Effects of Early Mobilization Protocol on Pre and Post Operative Functional Performance for Individuals with Post Abdominal Surgery

Background: The post surgical period of abdominal incision was accompanied with respiratory muscle dysfunctionand diminished physical capability. Limited upright mobilisation, exhaustion, and restricted lung abnormalities,among other functional issues, are linked to the early postoperative days. Improving pre-operative levels ofphysical functioning in individuals might be beneficial for post operative outcome.Aim: Aim of the study was to find out on which post-operative day the abdominal surgery participants get to thesame functional status as pre-operative status.Method: 40 Individuals hospitalized for abdominal surgery at Saveetha Medical College and Hospital werechosen for the study based on the inclusion and exclusion criteria. The selected participants were treated withdiaphragmatic breathing exercise, Incentive spirometry, thoracic expansion exercise, splinted coughing technique,active range of motion exercise for upper extremity and lower extremity for pre-operative abdominal surgeryparticipants. Post operative participants were treated with physiotherapy from POD 1 till the time their functionalstatus become same as the pre-operative status. Six- minute walk test, hospital anxiety and depression scale wereused in this study. Their scores were calculated and analysed.Result: Similar pre-operative mean (365.25±25.92) was attained at POD-7 (350.75±25.46). Day of POD-5, the HADSscore was normal (0 to7) in depression.Conclusion: This study shows the post-operative status is attained back on POD-7 with using 6MWT. Depressionwas relieved at POD-5 with a value of mean and standard deviation in HADS.

The effect of active range of motion exercise on foot sensitivity in type II diabetes mellitus patients

Background: Diabetes Mellitus (DM) is a metabolic disease that can be characterized by the presence of high sugar levels in the blood, resulting in an imbalance between insulin demand and production in the human body. One of the complications is peripheral neuropathy nerve damage, which causes diabetic ulcers, so there is a risk of decreased sensitivity to diabetics. Active Range of Motion (ROM) exercises are one effort to overcome this. The objective is to determine whether the active ROM of the lower extremities affects foot sensitivity in type II DM patients.
 Methods: The research used a pre-experimental quantitative research design with the one-group pre-test and post-test method. The sampling technique used purposive sampling with 22 respondents.
 Results: The analysis using the Wilcoxon test obtained a p-value <0.005. This indicates an increase in foot sensitivity in type II DM patients.
 Conclusion: There is an effect of active foot ROM on foot sensitivity in type II DM patients.

An exploratory international survey of the assessments and interventions used by occupational therapists and physiotherapists during the hospitalization of people with Guillain-Barré syndrome.

Guillain-Barré syndrome is a rare neurological condition. Although some people make a substantial functional recovery, almost half require intensive rehabilitation. Data were collected using a cross-sectional survey which investigated the assessments and interventions used by occupational therapists and physiotherapists for people with Guillain-Barré syndrome. Seventy valid responses were received from 10 countries. The survey highlighted four factors about current practice: (i) practitioners did not identify the use of formal clinical guidelines or protocols for Guillain-Barré Syndrome treatment of the upper limb; (ii) a range of standardized and non-standardized assessment and goal-setting tools are utilized; (iii) interventions include passive and active range of motion exercises, and the prescription of upper limb/hand splints; and (iv) interdisciplinary practice is common in the intensive care unit and during acute phases of Guillain-Barré syndrome, whereas discipline-specific work is more common during rehabilitation. A range of goal-setting and assessment tools are used by occupational therapists and physiotherapists during the hospitalization of people with Guillain-Barré syndrome. The type and duration of interventions vary and may reflect the lack of international protocols for Guillain-Barré syndrome rehabilitation.

Physiotherapy treatments for the patient with Bankart lesion repair: a case report study

Background: Bankart lesion is torn in the anterior membrane covering the shoulder joint (labrum) due to continuous dislocation of the shoulder joint forward. Bankart lesions can occur due to sports activities that use the front of the shoulder, such as javelin throwing. It is not uncommon for injuries to javelin-throwing athletes to require physiotherapy treatment so they can return to playing javelin-throwing.
 Aim: This study aims to determine the effectiveness of the training program such as ultrasound therapy and transcutaneous electrical nerve stimulation (TENS), active assisted range of motion (ROM) exercises, active assisted ROM exercises against gravity, strengthening exercises, wall climbing, and open cage exercises. to tourists who are javelin throwing athletes who experience Bankart lesions.
 Case Report: In this case, a 42-year-old man from France came to the physiotherapy clinic complaining of pain, stiffness, and limited movement of the right shoulder joint. The patient underwent surgery for Bankart shoulder repair on his right shoulder on October 16th, 2022, due to repeated dislocations three times during javelin throws. The patient has limited movement and pain in the right shoulder. In addition, the right hand also does not swing when walking. On static inspection, the chest, shoulder, and right arm are smaller (atrophied) and positioned lower than the left. There is an incision in the anterior deltoid area (post-Bankart repair shoulder). Intervention modalities included ultrasound therapy applications and transcutaneous electrical nerve stimulation (TENS). Exercise therapy includes active assisted ROM exercises, active assisted ROM exercises against gravity, strengthening exercises, wall climbing, and open cage exercises.
 Result: After interventions, the patient’s recovery condition improved. An exercise program designed and implemented on patients for two weeks has slowly raised the patient's self-confidence and increased the patient's ability to perform physical activities.
 Conclusion: The physiotherapy intervention program for a Bankart lesion patient showed an improvement in the patient’s condition, with an increase in ROM, an increase in muscle strength, and a decrease in perceived pain.

Importance of Physiotherapy in Post Pneumonectomy Renal Transplant Recipient: A Case Report

Pulmonary mucormycosis is a rare but opportunistic fungal infection that complicates immunosuppressed solid organ transplant recipients. Although antifungal medication is the remedial dependence in management of pulmonary mucormycosis, early surgical intervention provides advantage over medical treatment alone. However, major impairments and complications such as altered pulmonary and physical function induced by surgery are known to occur. We report the case of a 25-year-old male post renal transplantation on immunosuppression who developed invasive pulmonary mucormycosis in right middle and lower lobe. Liposomal Amphotericin B therapy provided insufficient infection control and lesion invaded the adjacent chest wall, ribs and intercostal muscles. After right pneumonectomy combined with anterior chest wall resection, the initial post-operative physiotherapy assessment was carried out. The patient was found to have productive cough, dyspnoea, chest pain, reduced chest expansion and excursion, limited range of motion of shoulder on affected side and limited activities of daily living. Six weeks of inpatient physiotherapy regime was given which included breathing exercises, thoracic mobility exercises, incentive spirometry, active range of motion exercises, positioning, bed mobility and early ambulation. Follow up assessment showed reduced pain intensity and improvement in oxygen saturation, dyspnoea, Timed up and go test (TUG) time, handgrip strength, activities of daily living and quality of life [Short form 36 (SF-36)]. Keywords: Pneumonectomy, Thoracic Surgery, Renal Transplant, Physiotherapy

Managing Stroke Rehabilitation in Elderly

The world's elderly population is predicted to triple every year, and have complex consequences such as the incidence of non-communicable diseases, one of which is stroke. Stroke is a disease of impaired brain function that is a global health problem. As many as 2.5% of the 500 thousand stroke sufferers experience disability and even mortality in Asian countries, especially Indonesia. The study describes a rehabilitation program for the stroke elderly with a family approach. Three elderly stroke survivors were given passive and active range of motion exercises in the extremities by their families accompanied by nurses for 10 consecutive days. The results were obtained that all three elderly experienced an increase in muscle strength in part of their extremities at one rate better. From this study, it can be seen that rehabilitation with a family approach can be used as an alternative to improve the mobility ability of the elderly after stroke at home

Simple Postoperative Exercise of Acute Achilles Tendon Rupture without Active Range of Motion Exercise

Simple Postoperative Exercise of Acute Achilles Tendon Rupture without Active Range of Motion Exercise

Effect of Fastened Ankle Multidirectional Jumping Exercise Program on Jumping Performance among Athletes with Chronic Ankle Instability: A Randomised Controlled Trial

Introduction: Chronic ankle instability leads to alterations of ankle joint function, especially during jumping and running leading to diminished athletic performance. Multidirectional jumping exercise program with fastened ankle are required to be explored to overcome the challenges faced by the clinicians for management of ankle injuries, as well as, early return of athletes to sports. Aim: To find out the effect of fastened ankle multidirectional jumping exercise program on jumping performance among athletes with chronic ankle instability. Materials and Methods: This single-blinded randomised controlled trial was conducted at Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India in June 2022, and included 30 athletes with ≥6 months of Grade I and II ankle sprain, with instability and history of two or more episodes of injury. All subjects were distributed into three groups of 10 each. Pain and ankle disability were assessed using Numerical Pain Rating Scale (NPRS), vertical jump test and Foot and Ankle Disability Index tool (FADI-sports module). Therefore, recorded at baseline, 3rd week, and 5th week of intervention. Group 1 received ankle active range of motion exercises, while Group 2 received multidirectional jumping exercises, and Group 3 received multidirectional jumping exercise program with fastened ankle. Before exercise the involved ankle was taped with rigid tape. One-way Analysis of Variance (ANOVA) was used for between group analysis and ANOVA using repeated measure were used for within group analysis. Results: There was improvement in experimental group (group 2 and 3) from baseline to 5th week. Group 3 showed significant improvement in pain (NPRS) with mean difference of 5.4 from baseline to 5th week, Vertical jump height (vertical jump test) with mean difference of 24.7 from baseline to 5th week, ankle disability (FADI-sports module) with mean difference of 42.80 from baseline to 5th week with p<0.001. whereas group 2 showed improvement in pain with mean difference of 5.2 from baseline to 5th week, vertical jump height with mean difference of 18.5 and ankle disability with mean difference of 44.9 from baseline to 5th week with p <0.001. Conclusion: The study concluded that, five weeks of fastened ankle multidirectional exercise program improved the jumping performance, among athletes with chronic ankle instability.

The effect of mirror therapy on joint movement, pain and functionality in acute upper limb burns

ObjectiveMirror therapy is aimed at developing a normal proprioceptive perception for the area with pain or movement restriction by making use of the person's monitoring of the healthy side movements thanks to the mirror's reflective feature. The aim of this study is to investigate the effect of mirror therapy on joint range of motion, pain and functionality in acute upper extremity burn injuries. MethodsDemographic and burn-specific data of individuals with upper extremity burns were recorded. Individuals were divided into two groups. Standard treatment was applied to the first group, and mirror treatment in addition to the standard treatment was applied to the second group for 30 sessions, 5 days a week for 6 weeks. In the standard treatment program, passive, active-assisted and active ROM, strengthening, stretching, resistant and functional exercises were applied. In the mirror therapy group, active exercises were performed on the healthy side by covering the burn area in the mirror box. Before and after the treatment, joint range of motion(ROM) was evaluated with Universal Goniometer, pain intensity was evaluated with Visual Analog Scale and upper extremity functions were evaluated with QuickDASH. ResultsA total of 32 (23 Male, 9 Female) individuals between the ages of 18–65 were included. The mean total burn surface area was 12.93 ± 9.80 in the standard treatment and 6.12 ± 2.96 in the mirror treatment. The groups were similar in terms of ROM change (p > 0.05). The pretest/posttest pain scores of both the standard therapy and mirror therapy groups were similar (p > 0.05). There was no statistically significant difference in terms of pretest and posttest QuickDASH scores according to the groups (p > 0.05). The difference between the pretest/posttest QuickDASH scores of both Standard treatment and Mirror treatment groups was statistically significant. ConclusionThis study showed that the standard physiotherapy and rehabilitation program applied in the acute period in upper extremity burns and the mirror treatment applied in addition to this program provide similar improvements in joint range of motion and pain.

Comparison of time-dependent resistance isometric exercise and active range of motion exercise in alleviating the sensitization of postoperative axial pain after cervical laminoplasty

BackgroundPostoperative axial pain (PAP) is a significant complication after cervical laminoplasty. ObjectiveTo investigate pain sensitization in PAP patients and effects of time-dependent resistance isometric exercise compared to active range-of-motion exercise on PAP. Study designRetrospective cohort analysis. Methods211 patients undergoing postoperative 12-week exercises were evaluated for pressure pain threshold (PPT), temporal summation (TS) and both cross-sectional area and fatty infiltration of paraspinal muscles preoperatively and 3 months postoperatively. There patients underwent Numeric rating pain scale (NRS) and neck disability index (NDI) 3 and 6 months postoperatively. ResultsAt postoperative 3-month assessments, fewer patients undergoing isometric exercise showed PAP compared to range-of-motion exercise group (14/98 vs. 34/113; P = 0.006), and pain-related assessments in the former were lower than the latter (NRS at rest: 0.3 ± 0.8 vs. 0.7 ± 1.4, P = 0.014; NRS with movements: 0.4 ± 1.0 vs. 1.0 ± 1.7, P = 0.015; NDI: 2.4 ± 6.3 vs. 6.7 ± 10.9, P = 0.002). Postoperative cross-sectional area was smaller in isometric exercise group (603.5 ± 190.2) than in range-of-motion exercise group (678.7 ± 215.5) (P = 0.033), and the former showed higher local-area PPT and lower TS than the latter (PPT: 3.9 ± 1.8 vs. 3.1 ± 1.6, P = 0.002; TS: 1.8 ± 0.9 vs. 2.2 ± 1.0, P = 0.003). PAP patients showed lower local-area PPT and greater TS than those without PAP in both isometric (PPT: 2.8 ± 0.7 vs. 4.0 ± 1.9, P = 0.019; TS: 2.4 ± 0.6 vs. 1.7 ± 0.9, P = 0.011) and range-of-motion (PPT: 2.2 ± 0.9 vs. 3.6 ± 1.7, P < 0.001; TS: 2.8 ± 0.8 vs. 1.9 ± 0.9, P < 0.001) exercise groups. ConclusionsBoth peripheral and central sensitization are involved in PAP. Time-dependent isometric exercise has more positive effects on PAP than range-of-motion exercise because of its advantages in improving pain sensitization.

How to fix a tibial tubercle osteotomy with distalisation: A finite element analysis

BackgroundAntero-medialisation osteotomy combined with a distalisation procedure may require a more stable fixation as the osteotomy fragment loses both proximal and distal support. This finite element analysis aimed to compare the mechanical behaviour of different fixation techniques in tibial tubercle antero-medialisation osteotomy combined with distalisation procedure. MethodsTibial tubercle osteotomy combined with distalisation was modelled based on computerised tomography data, which were acquired from a patient with patellar instability requiring this procedure. Six different fixation configurations with two 3.5-mm cortical screws (1), two 4.5-mm cortical screws (2), three 3.5-mm cortical screws (3), three 4.5-mm cortical screws (4), three 3.5-mm screws with 1/3 tubular plate (5), and four 3.5-mm screws with 1/3 tubular plate (6) were created. A total of 1654 N of force was applied to the patellar tendon footprint on the tibial tubercle. Sliding, gap formation, and total deformation between the osteotomy components were analyzed. ResultsMaximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm) were seen with two 3.5-mm screw fixation, followed by two 4.5-mm screws, three 3.5-mm screws, and three 4.5-mm screws, respectively, in the screw-only group. Overall, the minimum displacement was observed with the four 3.5-mm screws with 1/3 tubular plate fixation model. ConclusionsPlate fixation might be recommended for tibial tubercle antero-medialisation osteotomy combined with distalisation procedure because it might allow early active range of motion exercises and weight-bearing.

Pectoralis major and pectoralis minor transfer for irreparable subscapularis tendon tears.

Irreparable rotator cuff injuries in young patients with moderate to high levels of physical activity remain achallenging pathology for shoulder surgeons. Irreparable anterior rotator cuff injuries require treatment that seeks to restore the dynamic anterior forces of the glenohumeral joint. Among surgical treatment options, transfer of the pectoralis major and minor muscle, have shown good functional outcomes. This technique attempts to reproduce the vector of the subscapular muscle in cases with irreparable tear. Restoration of the dynamic external and internal couple forces to maintain the humeral head in the center of rotation. Pectoralis major transfer (PMa): Irreparable subscapularis tendon (SSC) tear in active patients without osteoarthritis. Pectoralis minor transfer (PMi): Irreparable superior SSC tear with concomitant irreparable supraspinatus tendon (SSP) tear in active patients with no osteoarthritis. Primary osteoarthritis Samilson gradeC, cuff tear arthropathy HamadaIII-V, infection, axillary nerve palsy, older patients with low physical demand, combination with irreparable SSP/infraspinatus tendon (ISP) tear for PMa or combination with irreparable ISP tear for PMi. General anesthesia and beach-chair position with the arm freely mobile in an arm holder. Deltopectoral approach. Exposure of the humeral head and confirmation of the irreparability of the subscapularis tendon. PMa: Detachment of the tendon to be transferred from the humeral insertion, blunt anatomic dissection medially. Exposure of the conjoined tendon and coracoid process. PMi: Detachment of the tendon with an osteotomy at the coracoid process. Passing the PMa or PMi tendon under the conjoined tendon. The PMa tendon is fixed in a2-row configuration, the PMi in asingle row with suture anchors to the lesser tuberosity. Shoulder abduction sling(30°) for 6weeks. Assisted range-of-motion (ROM) exercises with abduction/adduction 60-0-0°, internal/external rotation free-0-0° for 6weeks. Free active ROM exercises after 6weeks, muscle strengthening after 12weeks. The pectoralis major and minor transfer shows an improvement in strength and range of motion in young active patients and an improved Constant score (CS) in long-term follow-up examinations.

Effect of aerobic exercise on cognition in elderly persons with mild cognitive impairment

Objective: To determine the effect of aerobic exercise on cognition in elderly persons with mild cognitive impairment. Methodology: This randomized controlled trial was conducted at Physiotherapy Rehabilitation center of NCS University, Swabi Campus. The inclusion criteria were age group between 60 to 70 years, MMSE 18-23 and able to walk independently without use of assistive device. Those with musculoskeletal disorders, current medical condition for which exercise was contraindicated, had cardiac and respiratory disorders were excluded from the study. A sample of 60 patients were randomly divided into experimental and control group using sealed envelope technique. Treatment for the experimental group was moderate intensity aerobic exercise program i.e., walking and control group received active range of motion exercises and stretching 5days/week for 6 weeks. Control group performed gentle active range of motion exercises and stretching exercises to large muscle groups of lower limb and trunk muscles for 5-7 cycles of 10 repetitions for 20 mins for 5 days/week and training was continued for 6 weeks. MMSE, MoCA, Trail making Test A and B were done at baseline and after 6 weeks of intervention. Results: Of the 75 patients assessed, 60 were included; of them there were 30 in each group. Mean age was 62.49±1.82years. There were 35(56.5%) males and 24 (38.7%) females. Intra-group analysis showed significant improvement in outcomes measures MMSE, MoCA, TMT-A and B after six weeks of intervention in aerobic training group (p&lt;0.05). Inter-group analysis showed significant differences in scores of neurocognitive measures (p&lt;0.05) after six weeks of training. Conclusion: Aerobic exercise showed improvement in neurocognitive domains of elderly persons with mild cognitive impairment after 6 weeks of intervention.

Effects of early rehabilitation in improvement of paediatric burnt hands function.

BACKGROUNDHands are one of the most common burn sites in children. Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion (ROM), motility, and fine motor activities. Rehabilitation can improve the function of hands. But the optimal time of rehabilitation intervention is still unclear. Therefore, this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.AIMTo investigate the effects of early rehabilitation management of paediatric burnt hands. METHODSA total of 52 children with burnt hands were allocated into the early intervention group (≤ 1 mo from onset) and a late intervention group (> 1 mo from onset) between January 2016 and December 2017. The children received the same rehabilitation programme including skin care, scar massage, passive ROM exercises, active ROM exercises, compression therapy, orthotic devices wearing and game or music therapy. Rehabilitation assessments were performed before and after the rehabilitation treatment.RESULTSIn the early intervention group, the ROM of the hands was significantly improved after rehabilitation (P = 0.001). But in the late group the effect was not significant statistically (P = 0.142). In the early group, 38.5% of the patients showed significant improvement, while in the late group, 69.2% of the patients showed no significant improvement. The time from onset to posttraumatic rehabilitation (P = 0.0007) and length of hospital stay (P = 0.003) were negatively correlated with the hand function improvement. The length of rehabilitation stay was positively correlated with the hand function improvement (P = 0.005). CONCLUSIONThese findings suggest that early rehabilitation might show better results in terms of ROM.

A CASE REPORT ON IMPORTANCE OF SHOULDER PROPRIOCEPTIVE TRAINING AND PNF TECHNIQUES ALONG WITH CONVENTIONAL EXERCISES IN FUNCTIONAL RECOVERY OF THE INDIVIDUAL WITH ADHESIVE CAPSULITIS SECONDARY TO ROTATOR CUFF TENDINOSIS.

BACKGROUND AND PURPOSE Adhesive capsulitis is a condition where there is inammation of shoulder capsule (capsulitis) which in turn causes bands of sticky connective tissue (adhesions) between the joint's surfaces. Due to this (1) shoulder movement becomes painful and often completely restricted .The purpose of this case report is to highlight Importance of Shoulder Proprioceptive training and shoulder PNF techniques using theraband and inatable ball (30 cm) along with Conventional exercises in Functional Recovery of the patient with adhesive capsulitis secondary to rotator cuff tendinosis. CASE DESCRIPTION A 66-year-old female who presented with right shoulder pain and neck pain and limited range of motion (ROM) since 1 month with a past medical history of type II diabetes mellitus, hypertension and hypothyroidism on medication was diagnosed with adhesive capsulitis secondary to rotator cuff tendinosis based on clinical examination, ROM assessment, Radiographical investigations-MRI and past medical history. INTERVENTION The patient was treated for a total of 10 physical therapy sessions over the span of 2 weeks. Interventions included were incorporating shoulder proprioceptive exercises with a help of inatable ball and textured towel, shoulder PNF patterns using Red theraband along with cryotherapy(icepacks),mobilizations (Maitland grade 2) with oscillatory techniques, therapeutic exercises, Active assisted ROM exercises with the help of a wooden wand, capsular stretching, myofascial trigger point release, postural correction exercises, strengthening and home exercise program. Outcome measures included ROM goniometric measurements, pain rating scale, Angle reproduction test for proprioception, Manual muscle testing and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. DISCUSSION AND CONCLUSION This case report conclude that appropriate combinations of interventions including shoulder proprioceptive exercises with an inatable ball, shoulder pnf patterns(D1-D2) , stretching, mobilisations, MFR and strengthening exercises resulted in an improvement in overall functional performance of the patient with adhesive capsulitis secondary to rotator cuff tendinosis .An improvement in post-test scores of Manual Muscle Testing (MMT) , ROM , DASH scores was observed after 10 sessions. Rationale for treatment was based on various research articles. The treatment was altered based on patient's need and response.

Application Of Active Range Of Motion In Nursing Services And Care In Elderly With Stroke

Stroke is a big problem for the elderly in low-income countries (developing countries) than in high-income countries (developed countries). The Range of Motion Active stroke intervention is one of the non-pharmacological therapy efforts, exercises that are carried out to maintain or improve the level of perfection and the ability to move joints normally and completely to increase muscle mass and muscle tone. This study aims to identify the effect of providing Active Range of Motion exercise therapy in nursing services and care for the elderly with stroke problems. This type of research is a case study design research, which is a form of research (inquiry) or case studies and interventions about a problem that has a specificity (particularity). The results showed that the provision of Active Range of Motion was scored with the Pretest and Posttest scores. There is a change in the value of muscle strength in elderly stroke after being given Active Range of Motion exercise from the value of the muscle strength scale 2 to 3, 3 to 4, and 4 to 5. with data on the characteristics of stroke patients, namely age, gender and activities such as rarely exercising and not exercising repeatedly, this shows that the more frequent Active Range of Motion exercises can affect the assessment of muscle strength in stroke patients.

Effect of Bilateral Repetitive Protraction in Antispastic Position Of Suspended Upper Extremity on Motor Performance and Scapular Position in Stroke

Purpose: To find out the effect of bilateral repetitive protraction of suspended upper extremity in anti-spastic position with conventional therapy in patients with hemiplegia due to stroke. Methodology: A total of 36 subjects of hemiplegia due to stroke (post stroke duration more than 3 months) were recruited and distributed in two groups. Group 1 received bilateral repetitive scapular protraction in anti-spastic position of suspended upper extremity along with scapular mobilization in addition to conventional therapeutic exercises. Group 2 received Conventional therapeutic exercises consisted of task specific activity such as bilateral activity on pegboard, ball throwing activity and reaching activities, bilateral active range of motion exercises and weight bearing exercises for upper extremity. Outcome Measures: Universal Goniometer measurements and Fugl-Meyer upper extremity scale were taken prior to the beginning of treatment and after the completion of 4 weeks treatment protocol. Results: Overall results of the study showed significant improvement in active range of motion of the affected upper extremity for shoulder and elbow except wrist in experimental group only. Scapular spine distance improved in both the groups but more significantly in the experimental group. Fugl-Meyer assessment of upper extremity showed more significant improvement in experimental group post 4 week of intervention. Conclusion: Bilateral repetitive protraction in anti-spastic position of suspended upper extremity along with conventional therapeutic exercises for 4 weeks is more effective in improving scapular position and upper extremity motor performance as compared to conventional therapeutic exercise alone.

Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon.

Background:The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture.Methods:A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up.Results:Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up (P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively (P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery.Conclusion:The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery.Level of Evidence:Level IV, retrospective case series.