Physiotherapy Rehabilitation Program Research Articles

Functional Outcomes of Stroke Survivors after Physiotherapy Rehabilitation Program at a Tertiary University Teaching Hospital in Rwanda

BackgroundAfter suffering from a stroke, serious long-term disability occurs and physiotherapy is one part of rehabilitation for stroke survivors that plays a significant role in improving functional recovery, mobility and has positive impact on outcome.ObjectiveTo identify functioning outcomes of stroke survivors after physiotherapy rehabilitation.MethodologyBy using both retrospective and cross-sectional study designs, 71 stroke cases were identified, and a Modified Barthel Index (MBI) was applied to score functioning outcomes. Data were managed and analyzed using IBM SPSS Statistics for Windows version 21.0 (IBM Corp, Armonk, NY, USA).ResultsThe findings showed that patients who received physiotherapy rehabilitation improved in activities of daily living (ADL). This was demonstrated by changes in the total MBI that were 0.72 ± 1.59 on admission and 15.3 ±4.89 on current status (after physiotherapy rehabilitation). However, some failed to achieve expected outcomes even though they received physiotherapy rehabilitation. This could be attributed to delayed onset, frequency and duration of rehabilitation.ConclusionStroke survivors after physiotherapy rehabilitation showed improvement in activities of daily living. Hypertension has been identified as the most influencing risk factor of stroke. Financial constraints were also identified for those who struggle to achieve the highest outcomes due to poor attendance at physiotherapy rehabilitation. Appropriate management of hypertension is necessary to reduce stroke; and facilitation of those under rehabilitation will improve their participation in the rehabilitation for better outcome.Rwanda J Med Health Sci 2023;6(2):191-198

The effects of treadmill training on postural control and balance in children with spastic diplegic cerebral palsy: A cross-over controlled study

Background & Objective: Treadmill training (TT) is used for several targets as in walking speed and endurance in rehabilitation programs of children with cerebral palsy (CP). However, its effects on postural stability have not been fully explored. The aim of this study was to investigate the effects of unsupported TT on postural control (PC) parameters and balance in children with spastic diplegic CP. Methods: Twelve children with CP, level I-II according to Gross-Motor-Function-Classification- System (GMFCS) were included. Participants were divided into two groups using randomized-sampling method. The study was designed as a cross-over study. In the first phase, the first group underwent routine physiotherapy-rehabilitation program (PTR) 3 sessions/week, 45 minutes per session, for 12 weeks. In the second group, 20 minutes of TT starting with 0.5 km/h speed, was added to the same PTR (n=6). At the end of 12 week, 4-week-long wash-out period was given. After this 4 weeks period, both groups crossed-over for another 12 weeks at the second phase of therapy. All tests was applied at baseline and at end of the first and second phases. PC was evaluated with Balance-Master computerized posturography (Neurocom Inc.) which consisted of tests of modified-clinical-sensory- balance-interaction (MCSBT), weight-shifting-in-standing (WSST), limits-of-stability (LoST) and rhythmic-weight-shifting (RWST). Results: The two groups were similar in age, body composition, GMFCS Levels and spasticity levels before the treatment and after the wash-period (p>0,05). After TT, there were significant improvements in PC parameters, MCSBT: composite-balance-score (p=0.02), center of gravity alignment (p=0.02); WSST: symmetry (p=0.03); LoST: backward weight-shifting (p=0,02), end point reaching (p=0.02-0.04), maximum-orientation (p=0.02-0.04); RWST: direction- control (p=0.02-0.04), on-axis-velocity (p=0.02-0.04). Conclusion: Including TT in PTR treatment program can enhance PC and balance in children with CP.

A physiotherapy rehabilitation programme for patient with thermal burn injury: A case report

A physiotherapy rehabilitation programme for patient with thermal burn injury: A case report

Drivers of Successful Physical Therapy Rehabilitation Program following ACL Reconstruction: A Narrative Review

The speedy and effective return to performing activity of daily living or return to sports following an ACL reconstruction is one of the key challenges for a physical therapist in a clinical setup. Literature evidences state that drivers of a successful rehabilitation program can depend on a number of variable factors where large differences in clinical and outpatient protocols have been observed with limited consensus been formed. A range of factors including the surgery timing, choice of graft and above all the rehabilitation protocol with numerous PT interventions can influence the outcome significantly. The articular cartilage, joint capsule, menisci, and ligaments are some of the connective tissues of the knee joint involved in knee injury. Among the people of younger age group 20 years to 39 years the ACL injury has the highest prevalence. An untreated ACL tear causes knee instability, making it difficult for the affected person to return to sports. The duration and exercises used in different protocols vary significantly; hence, a review was conducted to identify the most effective techniques used by therapists to treat athletes who have undergone ACL reconstruction. An extensive literature search was conducted using Cochrane, Embase, Pedro, MEDLINE, and Saudi Digital Library to identify relevant articles published in English from January 2010 to June 2022. Most athletes underwent reconstruction surgery to improve their knee function. The current review helped us to know the various treatment strategies used for the clients who are under rehabilitation following ACL reconstruction surgery. The evidences support patient education, bracing, cryotherapy, Gait training, balance re-education, joint mobilization exercises and strength training exercises. All these interventions help the athletes to regain their functional mobility and support active participation in sports.

Efficacy of Physiotherapy Rehabilitation Program In Post Operative Management of Femoroacetabular Impingement Syndrome: A systemic Review of Clinical Evidence

Background: Femoroacetabular impingement syndrome (FAIS) is a well-known cause of hip pain in adolescentsand young adults. It is defined as the triad of symptoms, clinical signs and imaging findings in which structuralmorphology results in conflict between the femoral head and the acetabulum.Aim: To summarize the effects of physiotherapy rehabilitation in post operative management of FAI syndromeMethod: A literature search was carried out on the PubMed, EMBASE, Scopus, Google Scholar ,Chocrane,Research Gate and PEDrodatabases, using the following keywords: “femoroacetabular impingement”, “FAI”, inassociationwith “surgery”, “arthroscopy”, “surgical” and “physiotherapy”, “physical therapy”, “rehabilitation”,“exercise”. Studies meeting all inclusion and exclusion were reviewed and data were extracted.Results: The above review includesa total of 10 studies. In the present review, data from 1281 patients wereretrieved. Out of 1281 patients 820 were Male and 461were females. Furthermore, 117 cases were classified as acam impingement , 40 as pincer impingement and 1124 as mixed FAI. The weighted mean age was 35.10 years,outcomes included iHOT-33, HOS ADL , HOS SPORTS, VAS, MHHS.Conclusion: Rehabilitation protocols following hip arthroscopy for the management of FAI syndrome typicallyconsist of four to five phase programs with set goals and progression criteria. The study found Clinically significantimprovement in reported outcomes from baseline noted in majority of the studies reviewed that involved astructured rehabilitation program following arthroscopic management of FAI.

Clinical Documentation using ICF for a 12 years old Child with Cerebral Palsy- A case Study Approach.

Cerebral Palsy (CP) is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The purpose of the study was to present a framework for developing an ICF-based documentation system in Cerebral Palsy rehabilitation across the continuum of care by using a case study approach. A Case Report of a 12-year-old boy suffering from chore-athetoid cerebral palsy since birth. The report describes the integration of the ICF-based documentation tools into the patient’s examination, evaluation, prognosis, diagnosis, and intervention while he participated in a physiotherapy rehabilitation program for 4 months and the outcome measures used were GMFM and UFMG SYDENHAM’S CHOREA RATING SCALE at the baseline and after 4 months. The ICF-based documentation for physical therapists summarizes all relevant information to aid the physical therapist’s patient management. It also demonstrates, a viable framework both for physical therapy and multidisciplinary management and for clinical documentation.

Return to Job of a Construction Worker by Comprehensive Functional and Vocational Rehabilitation

BACKGROUND- Supracondylar humeral fracture is most common paediatric fracture around elbow. Most of these fractures arise as a result of fall from a height or due to fall on an outstretched hand (FOOSH). Undisplaced fractures are best managed by immobilizing the area using a cast or a splint. Displaced fractures are managed surgically by closed reduction and percutaneous pinning fixation. Loss of flexion, extension, or hyperextension, post immobilization tends to be the main functional issue. Physiotherapy aims to help patients regain their range of motion quickly and prevent late complications.CASE DESCRIPTION- Presenting a case of 12Y/O female with a supracondylar fracture of humerus who fell on the stage while playing on left side and was diagnosed with X-ray. She was managed surgically by closed reduction and percutaneous pinning with K- wires. Patient presented with the following complains post-operatively, i.e., pain at the incision site, swelling around the elbow joint and reduced movement at the elbow and shoulder joint. Patient underwent a 4weeks physical therapy rehabilitation program after the surgery and showed marked improvement in pain score, range of motion, muscle strength and functional activities.RESULT- The results demonstrated significant improvement in range of motion, muscle strength and pain reduction after post assessment was done. CONCLUSION- Immediate Physiotherapy Intervention program which includes manual therapy & therapeutic exercises for a postoperative case of supracondylar fracture in paediatrics can facilitate the activities of daily living and improved quality of life.

Maze Control Training on Kinesthetic Awareness in Patients with Stroke: A Randomized Controlled Trial.

Objective To determine the influence of adding maze control training to the selected conventional physical therapy on kinesthetic awareness in patients with chronic stroke. Methods Thirty adult patients of both genders with chronic cerebral stroke were assigned to control and experimental groups randomly: the control group (A) received the selected conventional physical therapy rehabilitation program, while the experimental group (B) received the same program as group A in addition to the maze control training. Measurements for sway index, risk of fall, and knee proprioception before and after 8 weeks of treatment (24 sessions; three times per week). Results There were significant decreases of both sway index and risk of fall in both groups (p ≤ 0.001 in all measures), significant improvements of the knee proprioception in 30° and 75° in the experimental group (p value = 0.016 and ≤0.001, respectively). The in-between groups' comparison showed significant differences corresponding to both the sway index and risk of fall (p ≤ 0.001), and a significant difference in 75° (p ≤ 0.001). Conclusion Adding maze control training to the selected conventional physical therapy improved the kinesthetic awareness in patients with chronic stroke.

Motor-based priming: isokinetic outcomes of aerobic exercise in children with spastic diplegia

IntroductionPriming is a behavioural change generated by preceding stimuli. Priming physical activities with aerobic exercise could improve performance and function. The study aimed to investigate the effect of aerobic exercise before a rehabilitation program on quadriceps peak torque in children with cerebral palsy of spastic diplegia.MethodsOverall, 32 patients participated in this study; they were randomly assigned to 2 groups. Patients in the control group (A) engaged in a selected physical therapy program, while those in the experimental group (B) performed aerobic exercise by using a bicycle ergometer followed by application of the same selected physical therapy program as received by group A. The treatment programs were conducted 3 times per week for 12 successive weeks. Measurements obtained included concentric peak torque of quadriceps muscle at 30° as well as 90°. These measures were recorded 2 times: before and after the application of the treatment program.ResultsThere were statistically significant differences when comparing pre- and post-treatment mean values in each group. Also, there was a significant difference in favour of group B with regard to post-treatment mean values.ConclusionsIn accordance with the applied procedures, aerobic exercise is effective in improving quadriceps peak torque in children with cerebral palsy of spastic diplegia when applied before a physical therapy rehabilitation program.

A rare genetic disorder of osteopoikilosis

A 30-year-old male patient admitted to a hospital experienced pain in the left knee for 10 years and right knee for 1 month which increased strenuous activity, with a history of COVID-19 1 year back. Multiple areas of sclerosis were seen on epiphysio metaphyseal area in the X-rays of the bilateral knee and the hip joints (A, B). In the X-ray of the vertebra, lipping of vertebrae was seen (C). Sclerotic lesions were seen in (A, B, C, D). The clinical signs and radiological features, sclerotic lesions, and low bone mineral density levels, all led to the diagnosis of a rare genetic case of osteopoikilosis (A, B, C, D). The patient began treatment with regular intake of calcium; 1000 milligrams per day, adequate intake of vitamin D; 800 milligrams per day, and 50 milligrams of intravenous methylprednisolone, with mild to moderate level of physiotherapy rehabilitation program. It is a rare disease of the bones, affecting 1 in 50,000, equally in both sexes, autosominal dominant, with all patients having LEMD3 gene mutation. It is usually an incidental finding, not associated with symptoms, but pain, joint stiffness, and joint effusion seen in 20 percent of patients.

Comparative study of role of physiotherapy alone versus physiotherapy combined with yoga in rehabilitation after a sports injury. What can a primary physician offer?

Posttraumatic rehabilitation of sports injuries involves physiotherapy. Additionally, nonsurgical treatment of sports injuries involves regular physiotherapy as a major treatment therapy. This study aimed to evaluate the effects of yoga in addition to regular physiotherapy on these patients. In the present comparative study, we evaluated the effects of regular physiotherapy alone versus physiotherapy combined with yoga on 212 patients following various knee injuries treated nonsurgically. The study was conducted after obtaining hospital ethical, committee clearance, and written informed consent from patients. The patients were assigned into two groups: group C (Conventional) and group Y (Yoga group). The patients in the regular group received physiotherapy rehabilitation program, whereas the yoga group received additional yoga once every day by a yoga expert during their hospital stay. We provided written guidelines and photographs of the yoga asanas and instructed to perform them 3 days/week once they were home. The data on WOMAC score were collected at 6 weeks, 3 months, and at 6 months from the day of discharge from the hospital. We noted that the yoga group patients showed a significant improvement (P < 0.05) in all modalities like pain, stiffness, and function subscales of the WOMAC scale. They experienced significant reduction in pain and stiffness compared with the regular or conventional group on the seventh postinjury day, 6 weeks, 3 months, and 6 months after the initial injury. In this study, a combination of regular physiotherapy and yoga provided better functional outcomes than physiotherapy alone.

IMPACT OF PHYSIOTHERAPY PROGRAMME ON QUALITY OF LIFE AND FUNCTIONAL INDEPENDENCE POST ANTERIOR MEDIASTINAL TUMOUR WITH MYASTHENIA GRAVIS

A thymoma occurs in approximately 15 per cent of adult diagnosed with Myasthenia gravis (MG). Recent studies have supported the active role of structured physiotherapy rehabilitation program post MG and its complicating symptoms. A male patient, 61 years old, was admitted to the physiotherapy out-patient department with present complains of lump in neck region with generalised weakness and early fatigability. From past two months, the patient faced difficulty in both basic and instrumental activities of daily living such as swallowing, transportation and regular hand movements. Investigation for the patient was carried out in which chest X-ray, CT chest and serum Ach R (positive) was done and was diagnosed with thymoma. Restricted muscle examination of the shoulder and scapular muscle was positive showing symptoms of chest pain and was rated 3/5 with associated discomfort giving away fatigue. The patient was operated for thymectomy which was an elective surgical procedure, operated under general an aesthesia for a duration of approximately 4 hrs. The patient was then referred for post-operative physiotherapy rehabilitation with incisional pain, cough with expectoration, early fatigue and reduced upper limb strength. The patient had a history of Type II Diabetes Mellitus. The focus of the physiotherapy rehabilitation program included airway clearance techniques, monitored graded bed mobilization, aerobic training and progressive resistance training. There was a significant improvement in the patient after 6 weeks of physiotherapy rehabilitation program. The early excision of thymoma with prompt tailor made supervised exercise program helps in early recovery and achievement of functional goal thus improving the quality of life and functional independence.

The Efficacy of Physical Therapy Rehabilitation Program for Women Following a Modified Radical Mastectomy: A Case Report

Background: The most commonly identified cancer is breast cancer. In either the lobules or the breast ducts, the cancer normally grows. Infiltrating ductal carcinoma is the most common subtype. It may appear as a lump or mass; changes in the skin or nipple; breast rash or redness; or lymphadenopathy.&#x0D; Presenting Complains and Investigations: the patient presented with the complains of swelling and pain in the left breast in lower outer quadrant since 6 months, which was initially small in size and gradually increased and reached up this level 2x2 cm which placed in infra areolar region covering lower inner and outer quadrant. USG and cytology reports showed bilateral breast with axilla. Right breast was normal, enlarged lymph node in the right axilla measuring 15.2 x 4.6 mm with maintained hilum S/O reactive lymphadenopathy. In left breast there is E/O ill-defined taller than wider irregular hypoechoic lesion with spiculated margins, measuring approximately 15.9 x 12.4 mm in lower inner quadrant containing multiple foci of calcification within showing central vascularity OB doppler on elastography lesion is stiff, in left axilla there is E/O on enlarged USG lymph node present measuring 10.2 x 6.7 mm with maintained hilum S/O reactive lymphadenopathy. Impression of F/S/O malignant lesion in the left breast lymphadenopathy.&#x0D; Diagnosis: Left sided infiltrating ductal carcinoma.&#x0D; Therapeutic Intervention and Outcomes: Physical therapy intervention involved a variety of range of motion exercises, strengthening exercises, resistance conditioning, breathing exercises, lymphoedema treatment and scar management. This intensive outpatient program is a successful way to enhance the mobility of the shoulder and ROM during the initial 6-week treatment cycle after surgery. Shoulder range of motion was increased, patient was able to do basic activities of daily living like dressing, bathing, combing, etc. Edema was reduced.&#x0D; Conclusion: Shoulder stiffness after modified radical mastectomy is the commonest complication. Upper limb mobility exercises reduced the shoulder stiffness. Breathing exercises improved the respiration. Strengthening and general aerobic exercises helped the patient to get back on her normal routine.

Effects of Inspiratory Muscle and Balance Training in Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial

ABSTRACT The aim of the study was to investigate the effects of inspiratory muscle and balance training on pulmonary function, respiratory muscle strength (RMS), functional capacity, and balance in children with hemiplegic cerebral palsy (CP). Thirty children with hemiplegic CP (Gross Motor Function Classification System I–II) included in this study. The control group (n = 15) underwent conventional physiotherapy rehabilitation program (CPRP) that included balance exercises, and the training group’s (n = 15) program included inspiratory muscle training (IMT) in addition to CPRP for 8 weeks. The outcome measures were pulmonary function test, RMS measurement, the six-minute walk test (6MWT), and balance tests. There were no significant differences in the score changes of pulmonary function, balance, and 6MWT distance between groups (p > .05), whereas maximum inspiratory and expiratory pressure further increased in the training group (p > .05). RMS assessment and the identification of children who need it, and adding IMT to CPRP will contribute greatly to the rehabilitative approach of children with CP.

Effect of physical therapy rehabilitation program combined with music on children with lower limb burns: A twelve-week randomized controlled study

BackgroundBurn injuries cause significant physical impairments that need comprehensive rehabilitation and coordination with the acute burn care team. Music had been shown to increase positive mood during exercise, which may result in motivation for participation in exercise programs. The current study aimed to evaluate the effect of physical therapy rehabilitation program combined with music therapy on children with lower limb burns. MethodsA twelve-week randomized controlled study including thirty pediatrics with lower limb burns. They were randomly assigned into two equal groups, 15 children per each. Group A received a physical therapy rehabilitation program combined with music therapy in addition to routine medical care. However, Group B received a physical therapy rehabilitation program without music therapy. Assessment of pain was by visual analogue scale (VAS), assessment of the range of motion (ROM) by goniometer, and gait assessed by GAIT Rite. The evaluation was carried before and after the interventions. ResultsBefore starting the study, no significant differences were detected between the two study groups (p < 0.05). The study results reported statistically significant improvement in VAS, ROM, and GAIT Rite in both groups after the intervention (p < 0.05). Group A showed greater improvement than group B in all outcome measures (p < 0.05). ConclusionPhysical therapy program combined with music therapy is an effective and safe modality for improving pain, range of motion, and gait parameters in pediatrics with lower limb burn. Also, physical therapy combined with music therapy is more effective than physical therapy alone in the treatment of pediatrics with lower limb burns.

The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses.

Simple SummaryAltered spinal posture in a horse often relates to an underlying musculoskeletal condition that results in a negative effect on performance and welfare. Equine physiotherapy aims to adapt a horse’s posture by prescribing strengthening exercises to improve spinal range of movement and facilitate contraction of specific muscles. The aim of this study was to test the reliability of an outcome measure to objectively measure thoracolumbar posture before and after physiotherapy exercises over a specific time-period. The adapted flexicurve ruler (aFCR) had excellent intra-rater reliability compared to a standard flexicurve ruler. There were significant increases in thoracolumbar flexion after physiotherapy intervention at the specific time periods, of thirty minutes and one hour, however no significant changes at twenty-four hours. The physiotherapy intervention tested was shown to produce a short-term postural change, and over time may allow a long-term postural change with frequent practice. Outcome measures are valuable within veterinary physiotherapy to support clinical reasoning and the aFCR is shown to measure thoracolumbar posture pre and post-physiotherapy. Creating a postural change in horses can aid in a rehabilitation programme with veterinary physiotherapy, aiming to relieve pain and stiffness. Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumbar shape using an adapted FCR (aFCR) in 37 horses. Subsequently, the thoracolumbar shape of 12 horses was measured using the aFCR before random allocation into two groups. Six horses acted as a control group and six horses underwent a series of DME, which included cervical flexion and lateral flexion baited stretches. Measurements were repeated prior to DME, at thirty minutes, one hour and at twenty-four hours after DME to assess thoracolumbar posture. The aFCR ruler had excellent intra-rater reliability compared to a standard FCR (aFCR: p = 0.146; intraclass correlation coefficient (ICC) 0.971; FCR: p = 0.0001; ICC 0.979). Significant increases in flexion occurred in the thoracolumbar region at 30 min (p = 0.027) and one hour (p = 0.046) after DME, but not at 24 h (p > 0.05) with no significant differences in the control group (p > 0.05) between baseline and subsequent times. The results suggest DME create a short-term postural change, determined by using an aFCR, which supports their use as part of a veterinary physiotherapy rehabilitation programme.

English

English

Impact of Physiotherapy rehabilitation program on postoperative ACL tear patient on prognosis leading to maintain consistency in sport

Anterior cruciate ligament (ACL) injury is a devastating injury that occurs at high frequency during involvement in competitive sporting activity. Typical treatment of ACL damage is a reconstruction of the anterior cruciate ligament (ACLR). It is projected that between 50 percent and 60 percent of ACL injured athletes will return to competitive sport. Athletes undergoing ACLR surgery are recommended for comprehensive rehab and preparedness to rebuild knee joint integrity and specific functional criteria to direct the comeback to sport to protect against secondary ACL damage.Patient main concerns were pain, with loss of strength and stability at the knee joint, the clinical findings found that there was a marked decrease in range of motion (ROM), and decreased strength of the quadriceps and the hamstrings.Diagnosis of case was grade 2 ACL tear which was confirmed by the MRI reports.The patient showed a great co-operation during the intervention period and now the subject is able to maintain his consistency in his sport. The outcome measures of physical therapy intervention progressed him in an enhanced athlete with return to his sport.

Effects of robotic rehabilitation on walking and balance in pediatric patients with hemiparetic cerebral palsy

BackgroundThe most prominent characteristics of hemiparetic cerebral palsy (hCP) children are structural and functional asymmetries. These children have low walking speeds, endurance and poor balance. The robotic walking devices repeat and experience symmetrical stepping at the corresponding speed and angles of the lower extremities. Research Question 1Are robotic walking devices effective in the development of walking in hCP children who can walk? Research Question 2How does the aerobic exercise experience with assisted and symmetrical movement affect the walking and local muscle, peripheral oxygenation of children with hCP? MethodsThis prospective, controlled study included 24 children with hCP. All children attended to a standard physiotherapy rehabilitation (PTR) program (three days a week for 12 weeks); those in the study group (n=12) also attended to an Robotic Gait Training (RGT) program three times a week. Evaluations performed before treatment, after treatment, and at the 3rd month after treatment included assessment of balance, functionality walking and measurements for oxygenation of vastus lateralis muscle and peripheral oxygenation.Results: The evaluations were similar for both groups before treatment. After treatment, walking speed, endurance and peripheral O2 saturation were increased and balance abilities and functional performances improved in the RGT group as compared with the pre-treatment evaluations; these improvements in balance and functional performance were generally preserved after 3 months of treatment. An increase in 6-min walking distance and a partial increase in gross motor functions and functional muscle strength were observed in the control group; however, these abilities were not preserved after the treatment. SignificanceRGT can provide a faster and higher effect on the development of functional muscle strength, balance, walking speed and endurance than the standard PTR program. It improves functional walking performance. RGT can be used for aerobic exercise training in children with walking hCP.

A study of the effect of the combined application of a physiotherapeutical program with therapeutic fit balls in cases of chronic pain in the lumbar area.

Objective: To investigate the efficiency of the combined application of a physiotherapeutical program with fit-ball exercises in cases of chronic pain in the lumbar area. Subjects and method: 38 out-patients aged 39 to 67, with chronic pain in the lumbar area (dating back from 5-7 years, with last exacerbation 5-6 weeks prior to the patients? inclusion in the study), participated in the study. The patients were divided into two groups-a test group in whose physiotherapy program fit-ball exercises were included, and a control group performing standard analytical exercise routines. The pain was reported in the Visual Analogue Scale of Pain Intensity (VASPI). Muscular testing was performed at the beginning and at the end of the physiotherapy program. The physiotherapy rehabilitation program was implemented once a day during the out-patients? procedures in medical centres, and three time a week-at home. Results and discussion: At the end of the period of monitoring the condition of the patients, changes in the nature of the pain were reported in both groups: with initial levels of VASPI 3.50 for both groups, at the end of the treatment program the level reported by the test group was VASPI 2.00, and VASPI 3.00-by the control group. The continuous physiotherapy program including fit-balls leads to an improvement of the movements and a reduction of the dysfunction in cases of chronic pain in the lumbar area of the spine. The exercise programs using fit-balls performed at home enhance the functional capacity of the lumbar spine.