Passive Mobilization Research Articles

Depression Diagnosis and Forecast based on Mobile Phone Sensor Data.

Previous studies have shown the correlation be-tween sensor data collected from mobile phones and human depression states. Compared to the traditional self-assessment questionnaires, the passive data collected from mobile phones is easier to access and less time-consuming. In particular, passive mobile phone data can be collected on a flexible time interval, thus detecting moment-by-moment psychological changes and helping achieve earlier interventions. Moreover, while previous studies mainly focused on depression diagnosis using mobile phone data, depression forecasting has not received sufficient attention. In this work, we extract four types of passive features from mobile phone data, including phone call, phone usage, user activity, and GPS features. We implement a long short-term memory (LSTM) network in a subject-independent 10-fold cross-validation setup to model both a diagnostic and a forecasting tasks. Experimental results show that the forecasting task achieves comparable results with the diagnostic task, which indicates the possibility of forecasting depression from mobile phone sensor data. Our model achieves an accuracy of 77.0 % for major depression forecasting (binary), an accuracy of 53.7 % for depression severity forecasting (5 classes), and a best RMSE score of 4.094 (PHQ-9, range from 0 to 27).

Study of Mechanical Behavior in Epiphyseal Fracture Treated by Reduction and Cement Injection: No Immediate Post-Operative Weight-Bearing but Only Passive and Active Mobilization Should be Advised.

The development of new percutaneous treatment techniques using a balloon for the reduction and cement for the stabilization for tibial plateau fractures (TPF) are promising. The biomechanical changes brought by the cement in the periarticular fracture are unknown. The objective of this study was to provide elements of understanding of the bone behavior in an epiphyseal fracture treated with cementoplasty and to define the modifications brought about by the presence of this cement in the bone from both an architectural and biomechanical point of view. In vitro animal experimentation was conducted. Bones samples were prepared with a cavity created with or without cancellous compaction, aided by balloon expansion following the same protocol as in the treatment of TPF. A uniaxial compression test was performed with various speeds and by using Heaviside Digital Image Correlation to measure mechanical fields. Preliminary finite element models were constructed with various boundary conditions to be compared to our experimental results.The analysis of the images permits us to obtain a representative load vs. time response, the displacement fields, and the strain distribution for crack initiation for each sample. Microcracks and discontinuity began very early at the interface bone/cement. Even when the global behavior was linear, microcracks already happened. There was no strain inside the cement. The finite element model that matched our experiments had no link between the two materials.In this work, the use of a novel correlation process highlighted the biomechanical role of the cement inside the bone. This demonstrated that there is no load transfer between bone and cement. After the surgery, the cement behaves like a rigid body inside the cancellous bone (same as a screw or plate). The cement provides good reduction and primary stabilization (mini-invasive approach and good stress distribution), permitting the patient to undergo rehabilitation with active and passive mobilization, but no weight-bearing should be authorized while the cortical bone is not consolidated or stabilized.

Even mild intervertebral disc degeneration reduces the flexibility of the thoracic spine: an experimental study on 95 human specimens

BACKGROUND CONTEXTIntervertebral disc degeneration represents one of multiple potential trigger factors for reduced passive spinal mobility and back pain. The effects of age-related degenerative intervertebral disc changes on spinal flexibility were however mainly investigated for the lumbar spine in the past, while intervertebral disc degeneration is also highly prevalent in the thoracic spine. PURPOSETo evaluate the effect of the degeneration grade on the range of motion and neutral zone of the thoracic spine. STUDY DESIGNExperimental study including combined radiological grading of intervertebral disc degeneration and biomechanical testing of 95 human thoracic functional spinal units (min. n=4 per level from T1–T2 to T11–T12) from 33 donors (15 female / 18 male, mean age 56 years, age range 37–80 years). METHODSDegeneration grades of the intervertebral discs were assessed using the validated x-ray grading scheme of Liebsch et al. (0=no, 1=mild, 2=moderate, 3=severe degeneration). Motion segments were loaded with pure moments in flexion/extension, lateral bending, and axial rotation to determine range of motion and neutral zone at 5 Nm. RESULTSAll tested specimens exhibited degeneration grades between zero and two. Range of motion significantly decreased for grades one and two compared with grade zero in any motion direction (p<.05), showing the strongest decrease in extension comparing grade two with grade zero (-42%), while no significant differences were detected between grades one and two. Similar trends were found for the neutral zone with the strongest decrease in extension also comparing grade two with grade zero (-47%). Donor age did not significantly affect the range of motion, whereas the range of motion was significantly reduced in specimens from male donors due to the significantly higher degeneration grade in this study. CONCLUSIONSEven mild intervertebral disc degeneration reduces the range of motion and neutral zone of the thoracic spine in any motion plane, whereas progressing degeneration does not further affect its flexibility. This is in contrast to the lumbar spine, where a more gradual decrease of flexibility was found in prior studies, which might be explained by differences between thoracic and lumbar intervertebral disc morphologies. CLINICAL SIGNIFICANCEThoracic intervertebral disc degeneration should be considered as one of multiple potential causal factors in patients showing reduced passive mobility and middle back pain.

Mechanical design and validation of an auxiliary active device for rehabilitation of the knee and quadriceps

Motion difficulties, specifically the walk and displacement, are very common afflictions, mainly caused by some type of injury. The recurrent kind of rehabilitation treatments involve exercises of active and passive mobility. The success in the treatment and the early return to sports activity depends largely on the rehabilitation process. This should begin immediately after the production of the wound or the surgical process to repair the damage. The objective of this work is to develop a low-cost, easy manufacturing and assembly device, capable of providing exercises of active mobility. We designed an affordable and adaptable six-bar Watt linkage, coupled to a conventional leg extension machine. Structural and dynamic studies determine its safeness and its efficiency. The results of the kinematic and dynamic studies showed that the available range of motion for the different configurations goes from 24° to 109°. Its structural integrity was analyzed, pointing out that the weakest link had a Factor of Safety of 1.3, while the highest presents a value of 14.7, so that, the material overpasses the load needs. Based on the obtained results, a six-bar linkage is a viable option for the development of low-cost, therapeutic active devices.

Evidence-Based, Implementable Motor Rehabilitation Guidelines for Individuals With Cerebral Palsy

Cerebral palsy is a life-long condition that causes heterogeneous motor disorders. Motor rehabilitation interventions must be adapted to the topography of the symptoms, ambulatory capacity, and age of the individual. Current guidelines do not differentiate between the different profiles of individuals with cerebral palsy, which limits their implementation. To develop evidence-based, implementable guidelines for motor rehabilitation interventions for individuals with cerebral palsy according to the age, topography of the cerebral palsy, and ambulatory capacity of the individual and to determine a level of priority for each intervention. We used a mixed methods design that combined a systematic review of the literature on available motor rehabilitation interventions with expert opinions. Based on the French National Authority for Health methodology, recommendations were graded as strong, conditional, or weak. Interventions were then prioritized by the experts according to both the evidence and their own opinions on relevance and implementability to provide a guide for clinicians. All recommendations were approved by experts who were independent from the working group. Strong recommendations as first-line treatments were made for gait training, physical activities, and hand-arm bimanual intensive therapy for all children and adolescents with cerebral palsy. Moderate recommendations were made against passive joint mobilizations, muscle stretching, prolonged stretching with the limb fixed, and neurodevelopmental therapies for all children and adolescents with cerebral palsy. Strong recommendations as first-line treatments were made for gait training for all adults with cerebral palsy and moderate recommendations as moderate importance interventions for strengthening exercises and ankle-foot orthoses for motor impairment of the feet and the ankles. These guidelines, which combine research evidence and expert opinions, could help individuals with cerebral palsy and their families to codetermine rehabilitation goals with health professionals, according to their preferences.

Effect of physical therapy on bone remodelling in preterm infants: a multicenter randomized controlled clinical trial

BackgroundPreterm infants have a low level of bone mineralization compared to those born at term, since 80% of calcium incorporation occurs at the end of pregnancy. The purpose of the present study was to investigate the effect of reflex locomotion therapy on bone modeling and growth in preterm infants and to compare its effect with those of other Physiotherapy modalities.MethodsA multicentre randomized controlled clinical trial was conducted (02/2016 – 07/2020). 106 preterm infants born at the Virgen de la Arrixaca University Clinical Hospital, the General University Hospital of Elche and the Torrecárdenas University Hospital of Almería, between 26 and 34 weeks with hemodynamic stability, complete enteral nutrition and without any metabolic, congenital, genetic, neurological or respiratory disorders were evaluated for inclusion. Infants were randomly assigned to three groups: one group received reflex locomotion therapy (EGrlt); another group received passive mobilizations with gentle joint compression (EGpmc); and the control group received massage (CG). All treatments were carried out in the neonatal units lasting one month. The main outcome measure was bone formation and resorption measured with bone biomarkers. A mixed ANOVA was used to compare the results of bone biomarkers, and anthropometric measurements.ResultsInfants were randomized to EGrlt (n = 38), EGpmc (n = 32), and CG (n = 36). All groups were similar in terms of gender (p = 0.891 female 47.2%), gestational age (M = 30.753, SD = 1.878, p = 0.39) and birth weight (M = 1413.45, SD = 347.36, p = 0.157). At the end of the study, significant differences were found between the groups in their interaction in bone formation, measured with osteocalcin [F (2,35) = 4.92, p = 0.013, ηp2 = 0.043], in benefit of the EGrlt.ConclusionsReflex locomotion therapy has been effective in improving bone formation, more so than other Physiotherapy modalities. Therefore, reflex locomotion therapy could be considered one of the most effective physiotherapeutic modalities for the prevention and treatment of osteopenia of prematurity.Trial registrstionTrial retrospectively registered at ClinicalTrials.gov. First posted on 22/04/2020. Registration number: NCT04356807.

Physical Therapy Protocols to Attenuate Skeletal Muscle Atrophy in Critically ill Patients: Narrative Review

To describe the physical therapy protocols used in critically ill patients to attenuate skeletal muscle atrophy. We conducted a search in PubMed and Embase from inception to November 2020. Observational or experimental studies published in English or Spanish that evaluated the effect of physical therapy protocols on the attenuation of skeletal muscle atrophy in critically ill patients through muscle strength or mass measurement were considered eligible. Studies were only included if they reported a detailed description of the dosing of the interventions. Seventeen studies met the eligibility criteria. We included randomised clinical trials (n = 16) and observational studies (n = 1). The total population of the included studies was 872 critically ill patients. The studies aimed to evaluate the reliability, safety or effectiveness of neuromuscular electrical stimulation (n = 10) protocols, early mobilisation (n = 3), ergometer training (n = 2), transfers in tilt table (n = 1), and blood flow restriction (n = 1). Physical therapy protocols are part of the critically ill patient's integral management. Strategies such as passive mobilisation, in-bed and out-of-bed transfers, gait training, ergometer training, and neuromuscular electrical stimulation substantially impact critically ill patients' prognoses and quality of life after hospital discharge.

Effects Of Physiotherapy on Strength, Range and Function in Children with Erb’s Palsy; An Experimental Study

Children who sustain brachial plexus injuries after birth face significant functional limitations due to a variety of sequelae affecting the shoulder, elbow, or forearm. These effects could be permanent or temporary. It is critical for proper joint development to maintain complete passive mobility while neurological function is being restored. Children with Erb’s palsy are more likely to have weak muscles, which can be found by ultrasonography Objective: To determine the effects of physiotherapy on strength, range and function in children with Erb’s palsy. Methods: It was a clinical trial conducted at physiotherapy department outpatient at General hospital Lahore. A sample of 46 children aged between 0-10 years, with the C5 and C6 lesion and with limited range of motion were included while children with any history of previous or recent trauma or surgery to upper limb and to the other roots of brachial plexuses was excluded. Modified Mallet scale and active movement scale was used as outcome measures. The coin toss technique of randomization was adopted, with 'Heads' assigned to strengthening exercises and 'Tails' assigned to general treatment. Independent sample test was employed to assess pre and post differences. Physiotherapy treatments included neurodevelopmental approaches to improve proprioception input, orthosis, and electrical current stimulation. Free weights, resistance bands and manual resistance were used in the strength training. The active range of motion was evaluated using goniometry, and a baseline measurement was generated using a modified mallet scale. The treatment was given every day for six months. Post-intervention measures were implemented two, four, and six months following the intervention. SPSS 25.0 was used for data analysis. Results: The finding showed that pre-interventional oxford scale muscle strength for experimental group showed the mean and standard deviation (1.434± 0.5068), control group (1.65± 0.48) while Oxford scale muscle strength post intervention showed the results with the mean and standard deviation for the experimental group 3.13± 0.54 and control group 2.65± 0.48 and showed significant p value less than 0.005. Conclusions: The study concluded that physiotherapy integrated approach improved upper limb strength, ranges and functional abilities in patients with Erb’s Palsy.

Association of sleep quality and chronification of musculoskeletal pain in an older adult: A case report

BackgroundSleep disorders and chronic musculoskeletal pain are highly prevalent conditions that are often comorbid clinically. The role of sleep disorder on the chronification of musculoskeletal pain is well documented, although the mechanisms have not yet been fully established. ObjectivesHere we present a case study demonstrating the clinical comorbidity of sleep disorder with chronification of musculoskeletal pain in an older adult with clinical history of hypothyroidism. The aim of this case is to highlight important risk factors of age, gender and hypothyroidism, which the clinician should be aware of for their potential contributory role in the development of sleep disorder and chronification of musculoskeletal pain. Clinical featuresPatient presented with a flare-up of pain in right shoulder and neck that had been intermittently present for several years but of which the intensity had become increasingly worse over time. The patient was diagnosed with chronic right rotator cuff tendonitis and a grade III supraspinatus tear. Clinical history revealed that significant sleep disorder and hypothyroidism were also present in this case. Intervention and outcomesTreatment focused on relieving pain and restoring function to the right shoulder. Interventions including passive mobilization, manual ischemic trigger point therapy, and passive traction were applied. Patient also provided with diaphragmatic breathing exercises to help alleviate her sleep disorder. After 12 weeks patient reported decreased pain levels and improved ROM of the right shoulder. Patient also reported improved sleep, both in quality and quantity. ConclusionThis case demonstrates the importance of considering the association between sleep disorder and the chronification of musculoskeletal pain in older adults. This study highlights common potential risk factors of age, gender and hypothyroidism which may contribute to the development of these conditions in older patients.

Measuring Tourism with Big Data? Empirical Insights from Comparing Passive GPS Data and Passive Mobile Data

Measuring Tourism with Big Data? Empirical Insights from Comparing Passive GPS Data and Passive Mobile Data

Views of American and Australian mobility device users and ambulant bus users regarding occupant restraint systems on public buses

IntroductionWith an ageing population, increasing numbers of people are using mobility devices, such as wheelchairs or scooters, whilst travelling on public route buses. The regulations and availability of active (wheelchair tie down and occupant restraint systems or WTORS) and passive (rearward facing) mobility device restraint systems on buses varies between countries. To date few studies have investigated passenger feedback on the use of restraint systems. This study aimed to gather feedback about WTORS on buses from passengers where these are in use (United States) and not in routine use (Australia) to guide decisions on their introduction. MethodsA prospective study using a purpose-designed electronic survey. Participants, predominantly recruited by Qualtrics, comprised two groups; mobility device and ambulant bus users in two countries; Australia and the United States (US). ResultsThe 448 participants rated the top two most important factors when deciding if buses should have WTORS as safety and comfort. Ninety-two percent of respondents believed people using mobility devices should use a WTORS which was rated 7.66/10 (SD1.97) as effective to prevent injuries to self or others. Only a minority of participants (13.2%) had ever slid or fallen from their mobility device, or seen a person slide or fall (13.6%) while on a bus with no differences between countries despite WTORS not being in use in Australia. Respondents reported it was OK to delay a journey an average of 5.52 (SD 2.89) minutes to secure/release a restraint system, which compares favourably to literature-reported real time of one to 4 min. ConclusionsAlthough WTORS were widely perceived by participants as important for safety, questions concerning their effectiveness to prevent slide or tip remain. Prior to the introduction of any securement system in Australia, the effectiveness of passive occupant containment systems to prevent slide or tip also warrants investigation.

Cyclists, dismount – car drivers, get out and push? An (auto)ethnographic account of long-distance commuting, joy, speed, and unexpected hurdles in Dutch traffic.

The&amp;nbsp;Netherlands&amp;nbsp;are&amp;nbsp;known&amp;nbsp;for&amp;nbsp;an&amp;nbsp;exemplary&amp;nbsp;cycle&amp;nbsp;infrastructure:&amp;nbsp;cycle&amp;nbsp;paths&amp;nbsp;all over the place, cycle traffic lights in abundance, and “cycle highways” emerging (Skov-Petersen et al., 2017; Liu et al., 2019; Cabral Dias and Gomes Ribeiro, 2020).*&amp;nbsp;At the same time, the micro-managed infrastructure does not always cater to a variety of cycle styles, speeds, and distances. This does not automatically render the paradisiacal image of cycling in the Netherlands as an example for cycling elsewhere. What makes long-distance cycling so different and difficult in a country with so many cyclists? The title “cyclists dismount” symbolically illustrates the failed match of policy versus use(s): “cyclists dismount (and walk)” has no equivalent for car drivers and therewith represents a systematic priority for motorized users of public road space. This reversal is the impetus for an exploration of long-distance cycling as active mobility (AM) in order to contribute to the notion of long-distance cycling as a sustainable alternative to passive (motorized) mobility (PM).*The original title was ‘cyclists, descend’, the direct translation in Dutch. Apparently, in English, cycling language/discourse is heavily influenced by equestrian culture (with thanks to Peter Cox for pointing this out).

Neurodynamics Is an Effective Intervention for Carpal Tunnel Syndrome.

Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS.

Interposition Arthroplasty in Untreated Chronic Dislocation of the Elbow.

Objective:To describe the clinical outcomes of interposition arthroplasty with transposition of the medial epicondyle to the coronoid process and articulated external fixation in patients with untreated chronic dislocation of the elbow.Methods:Fourteen consecutive patients diagnosed with untreated chronic elbow dislocation performed a complete radiological and physical examination. The same surgeon treated all patients with a same technique. Passive mobilization started immediately in addition to the vigorous care of the surgical wound and surrounding skin.Results:A total of 14 patients were treated, with a mean age of 31 years, with the nondominant side being the most affected (65%). In the immediate postoperative period, the initial Mayo Elbow Performance Score was 60 pts. In all cases, the distraction from the articulated fixator was removed, and there was an average of 16 pts improvement at the time of removal. A hinged elbow orthosis was placed for 4 weeks starting strengthening and obtained radiographic integration of the neocoronoids; ranges of motion of flexion 122°, extension −6°, and pronosupination 70°, without data of any direction instability.Conclusion:Considering that this is one of the longest series with a follow-up of more than 60 months of evolution in our patients, the result is completely satisfactory, achieving the objective of a minimum range of motion of 100° in addition to elbow stability.

Rapid chest compression effects on intracranial pressure in patients with acute cerebral injury

BackgroundPatients with acute brain injury often require invasive mechanical ventilation, increasing the risk of developing complications such as respiratory secretions retention. Rapid chest compression is a manual chest physiotherapy technique that aims to improve clearance of secretions in these patients. However, the rapid chest compression technique has been suggested to be associated with increased intracranial pressure in patients with acute brain injury. The aim of this work is to elucidate the effects of the technique on intracranial pressure in mechanically ventilated patients with acute brain injury. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied.MethodsRandomized clinical trial, double-blinded. Patients with acute brain injury on invasive mechanical ventilation > 48 h will be included and randomized in two groups. In the control group, a technique of passive hallux mobilization will be applied, and in the intervention group, it will be performed using the rapid chest compression technique. Intracranial pressure (main variable) will be collected with an intracranial pressure monitoring system placed at the lateral ventricles (Integra Camino).DiscussionThe safety of chest physiotherapy techniques in patients at risk of intracranial hyperpressure is still uncertain. The aim of this study is to identify if the rapid manual chest compression technique is safe in ventilated patients with acute brain injury.Trial registrationNCT03609866. Registered on 08/01/2018.

Association between out-of-bed mobilization during the ICU stay of elderly patients and long-term autonomy: A cohort study.

Our objective was to estimate the impact of the absence of Out-of-Bed (OoB) mobilization during intensive care unit (ICU) stay among patients ≥70years on their long-term autonomy. We conducted an ancillary study of the multicenter FRAGIREA study, including patients aged over 70years, admitted to ICU for more than 48h. We excluded the patients who died before day 180, who were lost to follow-up, and for whom the baseline autonomy (ADL) score was not available. Patients were classified into the OoB or non-OoB-mobilization group, and the impact of OoB mobilization on the decreased 6-month autonomy was estimated. Among the 548 patients of the FRAGIREA cohort, 276 were included in the present study. Among them, 226 had OoB mobilization and 50 did not. 220/276 (80%) patients experienced the transfer to chair as rehabilitation therapy, passive mobilization and transfer to upright sitting were also frequently performed. A decrease in the 6-month autonomy was observed for 63 (23%) patients. After the elimination of potential confounders, non-OoB-mobilization patients had a greater risk of 6-month decreased autonomy (aOR 2.43 [1.18; 4.98]). Mobilization during the ICU stay of elderly ICU patient survivors was associated with a lower decreased autonomy at 6months.

Arthroscopic Reduction and Internal Fixation of an Osseous Bankart Lesion.

The current surgical video article outlines a technique for an osseous Bankart repair in a patient with a displaced fracture as well as substantial pain and instability. First, the amount of bone loss is measured on 3-dimensionally reconstructed computed tomography (CT) imaging, with the humeral head digitally subtracted2. The procedure is then performed arthroscopically with the patient in the lateral decubitus position. A diagnostic evaluation, beginning with posterior and anterior portal placement in the rotator interval, is completed to assess any rotator cuff injury and the extent of labral tearing and osseous displacement. Next, the bone fragment is elevated into its anatomical position. This fragment is then reduced with use of a double-row suture technique, followed by concomitant capsulolabral repair. Nonoperative treatment with a sling can be utilized as long as post-reduction CT scans reveal anteroposterior centering of the humeral head on the glenoid3. Rehabilitation can include active-assisted and passive glenohumeral mobilization, as well as daily pendulum exercises and physiotherapy. Osseous Bankart repair has been shown to effectively improve patient-reported outcomes and normalize glenoid morphology1,3,4. Failure to recognize and appropriately treat an osseous Bankart fracture may lead to osseous erosion caused by repetitive episodes of subluxations or dislocations, along with substantial pain and weakness5. Indications for arthroscopic Bankart repair include young, active patients with a reducible fracture fragment, an anterior glenoid deficit of >10%, and a history of failed nonoperative treatment3-8. Clinical outcomes following the osseous Bankart repair procedure have been shown to be highly successful, with high rates of return to sport, minimal reduction in range of motion, and restoration of shoulder function and stability4. Additionally, long-term follow-up has shown successful osseous union and normalization of glenoid anatomy1. Apply tension to sutures with a suture retriever before the PushLock anchors (Arthrex) are placed during fracture reduction.Utilize a trans-subscapularis portal for anchor placement medial to the fracture on the glenoid neck.Perform adjustable tensioning during labral repair with knotless all-suture anchors.Utilize a lateral distraction device with the patient in the lateral decubitus position to completely visualize the anteroinferior glenoid.Chronic onset and late intervention may cause difficulties in the reduction of the bone fragment.Suture management may be difficult, particularly for surgeons at an early stage of the learning curve.A defect that is wide (from medial to lateral) may be difficult to maneuver around and reduce. GH = glenohumeralGHL = glenohumeral ligamentPts = patientsPMH = previous medical historyFE = forward elevationER = external rotationIR = internal rotationABD = abductionEXT = external rotationXR = radiographic imagingMRI = magnetic resonance imagingCT = computed tomographyROM = range of motionFU = follow-upRTS = return to sportsRTPP = return to previous level of play.

COMPARISON BETWEEN EFFECTS OF PASSIVE VERSUS SELF-MOBILIZATION OF SCIATIC NERVE IN PIRIFORMIS SYNDROME FOR RELIEVING PAIN AND IMPROVING HIP OUTCOMES

Background: Piriformis syndrome is disorder which is neuromuscular, caused by sciatic nerve compression and lead to compromised Hip functions. This problem, as well as the management for the restoration of hip functions need to addressed. Objective: To determine the effectiveness of passive mobilization versus self-mobilization in managing pain and improving quality of life in patients with Piriformis syndrome. Methodology: A quasi-experimental study was conducted at Imran Idrees Hospital Sialkot from April to October 2019. The simple random sampling was used to collect n=30 subjects with pain in the gluteal region from more than 2 months, both genders in age of 30-50 years were included. The Passive Sciatic Mobilization was given in one group, while other group was only taught the self-mobilization of the sciatic nerve along with home planThe Visual analogue scale and hip outcomes were measured at baseline, 2nd, 3rd, and 4th week using International Hip Outcome Tool (IHOT) Repeated measurement ANOVA for within-group and independent-sample t-test between groups were used. The level of significance was set at 95% (p&lt;0.05).Results: The mean age of participants in self-mobilization was 41.20 +5.79 and passive mobilization was 42.87 +4.82. Out of 30 participants, 17(56.66%) were male and 13(43.33%) were females participants. The mean of pain at baseline in experimental group was 4.86± 1.30 and reduced to 2.06 ± 1.09 after 4 weeks of passive mobilization and Hip functions at baseline was 131.73 ± 22.59 and improved to 232.00 ± 19.39. Between the groups comparison of pain and hip functions showing that both techniques were effective in reduction of pain and improving Hip functions but passive mobilization group has was dominant over the self-mobilization p value P =0.00 Conclusion: The current study concluded that passive mobilization of sciatic nerve was effective in the management of piriformis syndrome compared to the self-mobilization for improving pain and hip functions. Key words: Hip Functioning Pain, Nerve Mobilization, Piriformis Syndrome, Passive Mobilization,Sciatic Nerve, Self-stretching

Effectiveness of movement with mobilization (MWM) on pain, proprioception and muscle strength in diabetic frozen shoulder conditions

The term “frozen shoulder” was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease (Richard Dias et al, 2005). Brian Mulligan’s concept of Mobilization with Movement (MWM) is a natural continuance of the progression in the development of manual therapy from active stretching exercise to therapist applied passive physiological movement to passive accessory mobilization technique. (Deepali Rathod et al, 2019). Aims and Objectives: To evaluate the effectiveness of Mulligan Therapy along with conventional on Pain, ROM, Proprioception and muscle strength in patients with diabetic frozen shoulder. Methodology: 31 Patients were treated with Mulligan Therapy, Stabilization Exercise and Moist Heat Therapy. All the patients were selected after informed consent. These patients were interviewed by direct method. The patients were assessed in 0 (zero) week and reassessed in 4 (four) weeks and 8 (eight) weeks of treatment programme. Every 0 week 4 weeks and 8 weeks of treatment programme, pain, ROM, shoulder strength, shoulder Proprioception &amp; disability were recorded.

Features of active and passive joints mobility of skiers and skaters athletes

Introduction. In the vast majority of sports, joint mobility is a necessary basis for effective technical self-improvement. Insufficient mobility of joints sharply complicates and slows down the process of motor skills mastering, and some of it (mainly the key components of an effective technique for performing competitive exercises) cannot be mastered.Aim of the study is to reveal the features of the active and passive mobility of extremities joints in skiers and skaters athletes.Materials and methods. The study involved 46 athletes, including 27 skiers and 19 skaters. The inclusion criteria for the study were: age 18–24 years; lack of complaints from the musculoskeletal system; experience of constant sports activities for at least 2 years; absence of competitive practice during the research period. The protocol for the study of the joint mobility included 5 types of active and passive movements, the values of which were expressed in angular degrees: flexion and extension in the wrist joint, flexion in the knee joint, plantar flexion and dorsal extension in the ankle joint. The range of motion (both active and passive) in the joints was measured in both limbs using a goniometer.Results. In all the examined joints of all studied subjects, the volume of passive movements statistically significantly exceeded the volume of active ones (p&lt;0,05). Among athletes-skiers, the greatest differences were observed in the ankle joint during dorsal extension (29,4 %), and the smallest — in the knee joint (14,1 %). In the group of skaters, the smallest difference between passive and active mobility was recorded in the ankle joints — with plantar flexion (8,1 %). The maximum differences in passive and active performance of movements were found in the wrist joint — in flexion (29,4 %). Correlation analysis according to Spearman showed strong and moderate negative associations between active mobility and differences in active and passive movements. Conclusion. The amount of passive mobility in the joints always exceeds the amplitude of active movements. This creates the prerequisites for the development of active mobility at the expense of the reserve. This reserve in each joint has its own value and decreases with increased load on the joint, therefore, for different sports, the indicators of the reserve of mobility in the same joints differ due to the movements stereotyped for each sport. The maximum difference in active and passive movements is in the joints with the least load in the training process of athletes of a certain specialization. A decrease in the reserve of mobility increases the risk of injury and disrupts the athlete′s work capacity. Accordingly, the knee joints are the most vulnerable in skiers, and the ankle joints in skaters.