Early Physiotherapy Intervention Research Articles

Early Physical Therapy Management of a Patient with Diaphragmatic Eventration Following Diaphragmatic Plication: A Case Report

AbstractDiaphragmatic plication is the recommended surgical procedure for the treatment of diaphragmatic eventration in those who have failed conservative care. The present case report describes a 63-year-old male patient who presented with breathlessness on exertional activities. Chest X-ray and Computed Tomography (CT) of the thorax revealed diaphragmatic eventration on the right side. After failed conservative management, the patient underwent diaphragmatic plication surgery and was followed up with postoperative physical therapy management. Physical therapy intervention was started from 3 days postsurgery and was continued for 1 week. The treatment goals focused on reducing breathlessness, reducing pain on the incision site, preventing postoperative complications, and improving functional capacity. The present study highlights the benefits of early physical therapy interventions including incentive spirometer, dyspnea relieving techniques, Transcutaneous Electrical Nerve Stimulation (TENS), and light- to moderate-intensity aerobic exercises in the patient after plication surgery.

Impact of early physiotherapy intervention in managing homonymous hemianopia due to posterior cerebral artery infarct—a case report

Homonymous hemianopia field loss can develop as a result of injury to any part of the retro chiasmal visual pathway and is frequently fatal for subjects. The most common cause of homonymous hemianopia in older persons is ischemic infarction of the occipital lobe and its causes are multifactorial, frequently providing a diagnostic challenge to the clinician and signaling the necessity for a thorough systemic health review. Hemianopia is a loss of half of the visual field in each eye in which the inner or nasal half of one eye and the outer or temporal half of the other eye is affected. We report a case of a 72-year-old male subject who visited our department with complaints of weakness on the right side with difficulty seeing on the right side for 3 days. After undergoing various investigations, it was found that there is an acute infarct in the posterior cerebral artery territory supplying the left medial temporal lobe, medial occipital lobe, left thalamus, and splenium of the corpus callosum. After a physiotherapeutic examination provisionally, he was diagnosed with right hemiparesis and homonymous hemianopia, and thus, we administered an early physical therapy intervention which was found to be effective.

Role of Early Physiotherapy Intervention on Gastrectomy Surgery: A Case Report

Role of Early Physiotherapy Intervention on Gastrectomy Surgery: A Case Report

The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report

BackgroundTotal pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear.Case presentationA 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis.ConclusionStandardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Quantitative computed tomography analysis of body composition changes in paediatric patients with acute lymphoblastic leukaemia.

Children with acute lymphoblastic leukaemia (ALL) are at risk for obesity and cardiometabolic diseases. To gain insight into body composition changes among children with ALL, we assessed quantitative computed tomography (QCT) data for specific body compartments (subcutaneous adipose tissue [SAT], visceral adipose tissue [VAT], total adipose tissue [TAT], lean tissue [LT], LT/TAT and VAT/SAT at lumbar vertebrae L1 and L2) at diagnosis and at off-therapy for 189 children with ALL and evaluated associations between body mass index (BMI) Z-score and clinical characteristics. BMI Z-score correlated positively with SAT, VAT and TAT and negatively with LT/TAT and VAT/SAT. At off-therapy, BMI Z-score, SAT, VAT and TAT values were higher than at diagnosis, but LT, LT/TAT and VAT/SAT were lower. Patients aged ≥10 years at diagnosis had higher SAT, VAT and TAT and lower LT and LT/TAT than patients aged 2.0-9.9 years. Female patients had lower LT and LT/TAT than male patients. Black patients had less VAT than White patients. QCT analysis showed increases in adipose tissue and decreases in LT during ALL therapy when BMI Z-scores increased. Early dietary and physical therapy interventions should be considered, particularly for patients at risk for obesity.

START-Play Physical Therapy Intervention Indirectly Impacts Cognition Through Changes in Early Motor-Based Problem-Solving Skills.

This study tested whether the Sitting Together and Reaching to Play (START-Play) physical therapy intervention indirectly impacts cognition through changes in perceptual-motor skills in infants with motor delays. Participants were 50 infants with motor delays randomly assigned to START-Play plus Usual Care Early Intervention (UC-EI) or UC-EI only. Infants' perceptual-motor and cognitive skills were assessed at baseline and 1.5, 3, 6, and 12 months post-baseline. Short-term changes in sitting, fine motor skills, and motor-based problem-solving, but not reaching, predicted long-term changes in cognition. START-Play indirectly impacted cognition through motor-based problem-solving but not sitting, reaching, or fine motor skills. This study provided preliminary evidence that early physical therapy interventions that blend activities across developmental domains and are supported by an enriched social context can place infants on more optimal developmental trajectories.

The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT's Role in Return-to-Play, A Clinical Commentary.

Level V.

Evolución de la funcionalidad y la fuerza muscular desde cuidado intensivo a hospitalización en sobrevivientes por COVID-19

IntroductionThe critically ill patient hospitalized in intensive care unit (ICU), has a higher risk of deterioration in physical function. One way to counteract its related to early physiotherapy intervention, but there are few reports in patients with severe disease from COVID-19. ObjectiveTo describe the compromise and change in functionality and muscle strength in patients with COVID-19 who received early physiotherapy intervention in ICU until hospital discharge and compare the evolution according to whether or not they received invasive mechanical ventilation. MethodologyRetrospective study of patients with COVID-19 admitted to the ICU between March and September 2020 and received physiotherapy intervention. Functionality was assessed with the Barthel Index (BI) and muscle strength with the Medical Research Council Sum Score (MRC-SS), which were measured by the physiotherapist at two moments, upon discharge from ICU and from hospitalization. For the correlations, a value P<.05 was considered significant. ResultsSixty-six records were reviewed; the mean age was 53.3 (32±11.5) years; 32 (48.5%) required mechanical ventilation. Compromise in functionality and muscle strength was observed, with progressive improvement before hospital discharge: IB [64.1 (± 34.7) vs. 87.7 (± 18.4), P = .000], MRC-SS [40.5 (± 11) vs. 48 (± 9), P = .000]. The group of ventilated patients presented greater compromise: IB [34.2 (± 24.7) vs. 76.7 (± 21.2), P = .000] and MRC-SS [31.5 (± 7.2) vs. 42.3 (± 8.3), P = .000]. The days of mechanical ventilation, relaxation, and higher APACHE II showed a significant negative correlation with the outcome variables (P = .000). ConclusionsPatients with severe disease from COVID-19 who received physiotherapy intervention, showed significant changes in functionality and muscle strength. The patients who required mechanical ventilation presented greater functional compromise.

The impact of early mobility on functional recovery after hip fracture surgery

Purpose To examine the effect of early mobility (EM) on functional recovery after hip fracture surgery, and to investigate the potential factors that delay mobility. Methods In this retrospective observational study, 110 hip fracture patients were divided into two groups according to the days between surgery and mobility referred to as the EM and the delayed mobility groups. Demographic data, perioperative data, functional outcomes, and discharge destination were compared statistically between the groups using univariate analysis and logistic regression analysis. As a sensitivity analysis, the factors associated with the timing of physiotherapy were also assessed. Results The EM group had significantly better walking ability and Barthel index (p < 0.05), and home discharge rate (p = 0.004). The factors associated with delayed mobility (odds ratio; 95% confidence interval) were delayed postoperative physiotherapy initiation (3.59; 1.76–7.33), days from admission to surgery (1.23; 1.04–1.46), and postoperative CRP (1.14; 1.01–1.29) and hemoglobin level (0.72; 0.54–0.96). Furthermore, patients who received surgery on the day before any holiday were significantly delayed in physiotherapy intervention (p = 0.006). Conclusions This study demonstrated that EM after hip fracture surgery was associated with improving functional recovery and home discharge rate, and early physiotherapy intervention was associated with EM.

Physiotherapy management in a rare triallelic bardet- beidl syndrome

The Bardet–Biedl syndrome (BBS) is a rare ciliopathic human autosomal-recessive disorder, which is characterized principally by cardinal symptoms of marked central obesity, retinal dystrophy, polydactyly, mental retardation and hypogonadism and renal dysfunction.We report a case of 24 year old boy with Bardet-Biedl Syndrome, having classical symptoms like central obesity, hypogonadism, brachydactyly and strabismus. Laboratory investigations show reduced hemoglobin (6.1) and reduced WBC (700). Kidney function test (KFT) revealed an increased Urea level (130 mg/dl) and creatine (6.6mg/dl). Liver function test revealed (LFT) near normal bilirubin levels (1.4 mg/dl). CXR revealed subpleural fibrotic bands. Physiotherapy intervention included positioning, breathing re-training, chest PNF techniques, limb mobility exercises and HEP. The evidence from this study suggest that inpatient physiotherapy intervention plays a vital role in managing a patient with a rare case of Bardet-beidl syndrome. Early physiotherapy intervention has proven to be effective on this rare ciliopathic human autosomal-recessive disorder in ICU setup.

Early Physiotherapy Intervention Program for Preterm Infants and Parents: A Randomized, Single-Blind Clinical Trial.

Background: The early developmental interventions might be designed with a preventative approach to improving the development of at-risk preterm infants. The present study aimed to evaluate the effectiveness of an early physiotherapy intervention on preterm infants’ motor and global development, and on parents’ stress index. Methods: 48 infants were enrolled and randomized into two groups. Infants allocated to the intervention group received an early physiotherapy intervention, based on parental education sessions and tactile and kinesthetic stimulation during the NICU period, as well as a home-based activity program. The intervention commenced after 32 weeks post-menstrual age and ended at 2 months corrected age. Infants allocated to the control group received the usual care based on the NIDCAP-care. Results: No differences were found between groups on the Alberta Infant Motor Scale at 2- or 8-months corrected age. Infants in the intervention group showed more optimal fine motor, problem-solving, personal-social, and communication development at 1 month corrected age. Conclusions: The results showed no effect on the early physiotherapy intervention. Results might be related to the dose or intensity of the intervention, but also to the poor parental compliance. ClinicalTrials.gov NCT03313427.

PreEMPT (Preterm infant Early intervention for Movement and Participation Trial): Feasibility outcomes of a randomised controlled trial

PurposeInvestigate feasibility of PreEMPT: a novel participation-focused, early physiotherapy intervention for preterm infants in regional Australia. Materials and methodsParticipants were infants born <35 weeks, residing in regional Australia. Sixteen infants were recruited then randomised to usual physiotherapy care (UPC: n = 8) or PreEMPT (n = 8). PreEMPT involved 14-weeks of alternating clinic- or telehealth-based, participation-focused intervention. Feasibility was evaluated by: demand, practicality, acceptability, implementation and limited efficacy testing for infants (motor, participation) and parents (mental well-being, self-efficacy). ResultsDemand was lower than expected (45% recruitment rate). For practicality, attrition was high in the PreEMPT group (mean assessment attendance 3.8/5 sessions, range 2–5) compared to UPC (4.8/5 sessions, range 4–5). In addition, mean PreEMPT treatment dose received was approximately half intended (overall: 7.3/14 sessions, range 0–12; equivalent for face-to-face: 3.9/7, range 0–6, versus telehealth 3.4/7, range 0–6). The most common reason cited for treatment non-attendance was maternal mental health (22 sessions). Treatment acceptability for parents was high, with PreEMPT parents reporting they were offered choices in sessions (p = .02), and increased their knowledge (p = .01) and confidence (p = .009). There was a large effect size in favour of PreEMPT for increased parental self-efficacy (p = .021, ES = 1.34). ConclusionEarly post-discharge physiotherapy for preterm infants in regional Australia is beneficial according to families but logistically challenging.

Impact of physical therapy on a patient with complex comminuted fracture of elbow

Elbow joint make up to 4.3% of all fractures. Elbow joint consists of humerus radius and ulna of which humerus forms the proximal attachment while radius and ulna forms distal attachment. humerus being one of the major bone of upper limb any fracture needs to be given special consideration. Early rehabilitation can make the difference between a functional limb and an extremity with permanent loss. The rehabilitation goal is the rapid restoration of function with the attention given to prevention of deformity. A 52 year old male patient accountant by occupation with right hand dominance came with the complaint of reduced range of motion and pain in the right elbow. Patient presented with the history of fall in his home 2 months back, following which he had fracture of elbow. Patient was brought by the relatives in the casualty. After that X-ray and CT was done which showed comminuted fracture in the distal end of humerus. Patient was diagnosed with displaced comminuted fracture of elbow right side. Therapeutic intervention for the patient comprised of patient education, thermotherapy, and range of motion exercises, joint mobilization and progressive resistive exercise. Final outcome of all this intervention showed improvement in function. Early physiotherapy intervention after surgical fixation should be started to improve quality of life, forearm functioning and prevent chronic disability. Keywords: Comminuted fracture of elbow, Physiotherapy, Rehabilitation, Physical therapy.

Effect of myofascial release, stretching, and strengthening on upper torso posture, spinal curvatures, range of motion, strength, shoulder pain and disability, and quality of life in breast cancer survivors.

Breast cancer survivors are known to develop upper torso pain and stiffness including shoulder elevation and ipsilateral inclination of the trunk within a short period of time as a result of cancer adjuvant therapies correlating with the type and side of surgery. Hence, the study. Twenty-two breast cancer survivors at a tertiary care hospital, Belgaum, Karnataka, have participated in this pre-post experimental study which included myofascial release (MFR), stretching, and strengthening for four sessions per week for 3weeks that is, a total of 12 sessions. The participants were assessed at baseline and post-intervention using photogrammetry for Posture and shoulder range of motion (ROM), flexicurve for spinal curvatures, digital inclinometer for cervical ROM, manual muscle testing and hand dynamometer for strength of the upper back, shoulder muscles and hand grip, Shoulder Pain and Disability Index (SPADI) for shoulder impairment and Functional Assessment of Cancer Therapy-Breast (FACT-B) for quality of life. The outcomes were analyzed with a p-value set at ≤0.05. The results of the study demonstrated a substantial improvement in the posture alignment (p=0.001), shoulder and cervical ROM (p=0.001), upper back and shoulder muscle and hand grip strength (p=0.001), SPADI (p=0.001), and FACT-B (p=0.001) values. The upper torso malalignment and muscular imbalance is seen in patients who has undergone surgeries involving the chest wall and early physiotherapy intervention can benefit the patients overall physical performance and quality of life. Hence, MFR, stretching and strengthening has shown to be beneficial in improving upper torso malalignment in breast cancer survivors. The suggested techniques can be applied at a larger scale which can involve patients with head and neck cancer since the areas of intervention are identical. CTRI (Clinical Trial Registry- India) Registration No.: CTRI/2021/01/030453.

Effects of Early Physical Therapist-supervised Walking on Clinical Outcomes after Liver Resection: Propensity Score Matching Analysis.

The study aimed to demonstrate the significance of early postoperative physical therapy interventions on clinical outcomes by determining the influence of the distance walked under the supervision of a physical therapist in the early postoperative period after liver cancer. All consecutive patients who underwent surgery for liver cancer between April 2018 and March 2020 were eligible for enrollment in the study. The total walking distance during physical therapy till the third postoperative day was examined. The clinical outcomes comprised duration of postoperative hospital stay, time to independent walking, and occurrence of postoperative complications. For data analysis, the patients were divided into two groups: those who walked more than the median total distance (the long-distance group) and those who walked less than the median distance (the short-distance group). We used propensity score matching to match the background characteristics between the groups. Of the 65 patients who were eligible, 14 patients were included in the two groups each, after matching. The long-distance walking group had a significantly shorter hospital stay (9.0 days vs. 11.0 days, p=0.008) and a shorter time to independent walking (3.5 days vs. 7.5 days, p=0.019) than the short-distance walking group. There were no significant differences in postoperative complications between the two groups (7.1% vs. 42.8%, p=0.08). In the early postoperative period after liver cancer surgery, increasing the walking distance under the supervision of a physical therapist is important for improving clinical outcomes. Further prospective studies are needed to confirm the findings of this study.

REHABILITATION OF PATIENT WITH VARICOSE VEIN ALONG WITH SUBCUTANEOUS CALCANEAL BURSITIS

Varicose veins are permanently dilated tortuous and elongated path causing abnormal circulation. The varicose vein is the most common condition among females. The prevalence of varicose veins shows that females are more affected by it. In India, it is most common in females due to long-standing household work. Varicose veins are classified according to the long great saphenous vein varicosity, short/small saphenous vein varicosity, and varicose veins due to perforator incompetence. The calcaneal spur is also known as a heel spur and it occurs due to a bony outgrowth that is present in the heel bone. The heel spur is located at the back of the heel or under the sole. The spur occurring in the back of the heel is often associated with Achilles tendinopathy and the spur under the sole is associated with plantar fasciitis. A 55-year-old female with right-hand dominance came with complaints of pain in both the lower limb, pain in the neck region, and heel pain with these complaints patient was referred for physiotherapy after Ayurveda treatment. The patient presented with a history of osteoarthritis 5 years back, following which she started having pain in both the lower limb and heel. Patient were diagnosed with varicose vein and calcaneal spur with cervical radiculopathy. Therapeutic intervention for the patient comprised of patient education, thermotherapy, ultrasound, TENS, strengthening exercises, and range of motion exercises. The outcome of all this intervention showed improvement in function. Early physiotherapy intervention after diagnosis should be started to improve quality of life, activities of daily living, and prevent chronic disability.

POST HYSTERECTOMY PHYSIOTHERAPEUTIC PROTOCOL FOR CORE MUSCLES AND PELVIC FLOOR MUSCULATURE STRENGTHENING IN CASE OF ADENOMYOSIS

Adenomyosis is an important gynecological condition. It is considered a benign uterine disorder that shows a pathological demonstration of the endometrial gland and stroma in the uterine myometrium. A 42 years old female patient presented with excessive bleeding during menses and irregular menstrual cycle with dysmenorrhea, for 7-8 months. The patient complains of pain for 7-8 months in the lower abdomen region, in the iliac fossa on both left and right side, and is insidious in onset. The patient went to a private hospital where she got diagnosed with adenomyosis and suggest removal of the uterus. The investigation was done which includes CBC, KFT, LFT, and USG abdomen and pelvis which reviled that patient is having Adenomyosis. Vaginal hysterectomy is the least invasive type of hysterectomy, which is having lesser costs and risks which can also be done in women having uterus weighing more than 280g. For managing postoperative complication of hysterectomy various physiotherapy intervention could be given which includes pelvic strengthening exercises, core strengthening, breathing exercises, and yoga poses. The study concluded that hysterectomy may result in post-surgical manifestations which can be effectively managed by early physiotherapy intervention which impacts on quality of life of the patient.

POST-CONCUSSION PHYSICAL THERAPY REFERALS

Background:Treating a concussion is complex, requiring a multi-disciplinary patient-centered approach for optimal outcomes. Physical therapy (PT) is a treatment utilized to facilitate concussion recovery, however little is known about those patients referred to PT.Purpose/Hypothesis:The purpose of this study was to report the demographics and other outcome measures of patients referred to PT from an attached specialty concussion clinic.Methods:Retrospective data were extracted from medical records for patients who were referred for physical therapy (PT) from its specialty concussion clinic. Patients included in this study were aged 8-18, diagnosed with a concussion, and referred to PT. Demographic data (age, gender, ethnicity, race) were patient reported. Other patient outcome measures (total injury recovery in days, total number of PT visits, total days between the first and last PT visit, positive VOMS score (symptom increase of 2 from baseline on any symptom and/or convergence on any trial >6cm). Statistical analyses included summary statistics and were reported appropriately as proportions, medians (interquartile range [IQR]), and means (± standard deviation [SD]).Results:Of the 88 patients referred to PT, the mean (± SD) age was 14.31 (± 2.58), 27.3% were children (8-12 years), 72.7% were adolescents (13-18 years), 65.9% were female, 87.5% were white race, 6.8% were black race, and 12.5% were Hispanic in ethnicity. A total of 84.1% patients had a positive VOMS, 9.1% had a negative VOMS, and 6.8% had an invalid VOMS. On average, patients were seen for 4 (± 2.60) total visits, spanning across an average of 18 (± 14.83) days between initial and last PT visits, with the median recovery between date of injury and medical clearance being 48 days (SD=175).Conclusions:This is the first study to provide preliminary demographics of post-concussive PT patients referred from its specialty concussion clinic. These results will be useful in establishing future protocols for future studies to examine the effect of early PT intervention on pediatric concussion recovery.

Course of recovery in COVID-19 patients with pre-existing post Koch’s sequelae

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 predominantly causes respiratory disease in the form of viral pneumonia. Susceptibility to SARS-CoV-2, its progression and severity increases with presence of latent or active pulmonary tuberculosis (PTB). PTB is a highly prevalent respiratory disease in India. This case series explains the rehabilitation and course of recovery in ICU of two COVID-19 patients with post PTB sequelae. Both the cases showed safe and timely recovery due to appropriate and early physiotherapy intervention which needed modification in accordance with the medical management. However, their reduced functional capacity on pre-discharge assessment highlights the need for continuing pulmonary rehabilitation.

Early physical therapy intervention in adolescent athlete with L5 Spondylolysis and grade 1 L5-S1 Spondylolisthesis: a case study.

Early physical therapy intervention in adolescent athlete with L5 Spondylolysis and grade 1 L5-S1 Spondylolisthesis: a case study.