Regular Physiotherapy Research Articles

Case Report on Bell’s Palsy and Diabetic Ketoacidosis due to Uncontrolled Diabetes

Diabetic ketoacidosis (DKA) is a life-threatening condition seen in diabetes in which body cannot use glucose as a fuel instead uses fat and produces ketones (chemicals) and finally results in diabetic ketoacidosis. Bell's palsy is a sudden weakness or paralysis of the muscles on one side of the face due to mal-function of cranial nerve VII (facial nerve), which stimulates the facial muscles. Bell's palsy affects about 23 of 1,00,000 people at some time. The cause of Bell's palsy is unknown, but it may involve swelling of the facial nerve as a reaction to an immune disorder or a viral infection. Swelling causes the nerve to be compressed and its blood supply to be reduced. In this case facial nerve has got damaged due to diabetic ketoacidosis (mononeuropathy). Risk factors are the virus that have been linked to Bell's palsy include the virus that causes: cold sores and genital herpes (herpes simplex), chickenpox and shingles (herpes zoster), mononucleosis (Epstein-Barr), cytomegalovirus infections, respiratory illnesses (adenovirus), German measles (rubella), mumps (mumps virus), and flu (influenza B). Clinical features include numbness in the face, headache, eye can't get closed and gets dry resulting in eye damage. Diagnosis is done by CT-scan, MRI scan and blood tests. Treatment involves corticosteroids and anti-viral drugs. Bell's palsy can be cured in few months such as 2 to 3 months with regular medications and physiotherapy.

Comparative Study Between Short Segment Open Versus Percutaneous Pedicle Screw Fixation with Indirect Decompression in Management of Acute Burst Fracture of Thoracolumbar and Lumbar Spine with Minimal Neurological Deficit in Adults

The objective of this prospective randomized study was to compare the immediate and long-term clinico-radiological outcome of short segment open versus percutaneous pedicle screw fixation with indirect decompression achieved via distracting the posterior pedicle screw construct in management of single level acute thoracolumbar and lumbar burst fracture (TLBF) with minimal neurological deficit in adults. All patients had burst fracture of less than 72 hours and loss of vertebral body height ≥50%, angulation ≥30⁰, kyphotic deformity ≥20⁰, canal compromise ≥40⁰, failure of at least 2 columns, with intact pedicle and minimum neurological deficit [Grades C and D; according to American Spinal Injury Association (ASIA) grading system. Fractures treated either via short segment open pedicle screw fixation with indirect decompression (OPSFD) or short segment percutaneous pedicle screw fixation with indirect decompression (PPSFD) techniques, were corrected using a titanium monoaxial pedicle screw construct. Post-operatively all patients were advice brace and subjected for regular physiotherapy and followed up to 1 years. Data regarding peri-operative events, clinico-radiological outcome, duration of hospital stay and period taken to return to work was collected and analysed. Those patients treated with PPSFD techniques demonstrated superior outcomes compared to conventional OPSFD techniques, with significantly reduced operative time and blood loss during surgery, hospital stay, better neurological outcomes and early return to work. However, there was no significant difference in view of radiological improvement between the two surgical techniques. We would recommend PPSFD techniques as the best way of treating acute single level TLBF with minimum neurological deficit in adults.

Spondylolisthesis Grade III

Clinical Presentation: A 72 year female presented with complaint of pain in back since 45 days radiating to both lower limb (anterior aspect) aggravated since 7 days. She went to orthopedician where she was advised for X-ray investigation and diagnosed as spondylolithesis and was referred to physiotherapy department for further treatment. She came to The Oxford College of physiotherapy outpatient department on 7th June 2016. Similar episode was experienced 15 years ago, for which she took physiotherapy treatment at Indore for 2 months and followed by one of physiotherapy treatment she felt better. So stopped to follow-up and routine exercise advised by the therapist. She is a known case of diabetes and hypertension since 35 years. She had undergone hysterectomy 30 years ago. Presently she has complaints of dull aching, intermittent pain which is aggravated on walking, standing and relieves on rest and medication. Pain on Visual Analog Scale was 8 on 10. On observation, step sign present presence of Trendelenburg gait. On palpation grade 1 tenderness over S1 level, paraspinal muscle spasm present, trigger points were present over piriformis, hamstrings, gastrocnemius. On assessment straight leg raise and prone knee bending was positive suggesting of neural tissue involvement. On X-ray investigation, osteophytes formation in cervical, thoracic and lumbar region, anterior slipping of L5 over S1 indicating spondylolisthesis. A clinical finding reveals (Figures 1 and 2) that spondylolisthesis grade III which means 50% to 75% anterior slipping of L5 vertebrae over S1. (Figure 2 with down arrow). Regular physiotherapy follow-up was advised to the patient. Physiotherapy management as follows spinal flexion exercises, core strengthening, stretching the hamstring and calf muscles. Spinal extension exercise strictly contraindicated. After the few sessions of physiotherapy, she felt comfortable.

Management of chronic shoulder pain with restricted mobility - a case series.

Management of chronic shoulder pain with restricted mobility - a case series.

Effect of holiday on postural tone and selected parameters of body posture in young people with Down syndrome

Abstract Background: Regular physical therapy of people with Down syndrome improves the efficiency of such treatment. However, it remains unclear whether a discontinuation of the therapy over the period of summer holiday influences the effects of the therapeutic process. The aim of this study was to evaluate the effect of summer holiday on postural tone and quantitative parameters of body posture (angle of trunk rotation in the transverse plane and the spinal curvatures such as kyphosis or lordosis in the sagittal plane) in young people with Down syndrome. Material/Methods: Twenty one people aged 14 to 24 years were examined, with IQ scores from 54 to 35 on the Wechsler Intelligence scale. The experimental group was young people with Down syndrome whereas the control group were people with moderate intellectual disability without additional neurological, orthopaedic and other genetic disorders. The postural tone coefficient (PTC) and values of the spinal curvature (lordosis and kyphosis) and angle of trunk rotation (ATR) were evaluated twice. The first measurement was performed after 10 months of regular neurorehabilitation according to the neurodevelopment concept while the second - after 2 months of summer holiday. Results: During the holiday, the PTC value reduced significantly in the controls, from 0.40 to 0.37 (p=0.02), whereas in young people with Down syndrome, postural tone did not change significantly (p=0.33). In terms of the parameters of body posture, one significant change was observed in the group of patients with Down syndrome (kyphosis, p=0.00). Conclusions: No significant correlations were found between postural tone and values of kyphosis, lordosis and angle of trunk rotation, except for the relationship between PTC and angle of trunk rotation obtained in the main thoracic measurement (Th5- Th12, p=0.03).

Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction

Perioperative peripheral neuropathies are a significant cause of post-operative morbidity in patients undergoing prolonged procedures. The aims of this study were to determine the incidence and possible causes of peripheral neuropathy in patients undergoing abdominal free flap breast reconstruction and to develop methods of ameliorating this problem. A 4-year retrospective study of patients undergoing abdominal free flap breast reconstruction by a single surgeon and anaesthetist was undertaken to determine the incidence and potential causes of perioperative neuropathy. A new positioning protocol was introduced to minimise the stretch on the brachial plexus and to protect peripheral nerves from compression forces. In addition, regular intraoperative physiotherapy was introduced. A prospective study was then conducted on patients managed by the same team to evaluate the effect of this change in practice on the subsequent incidence of peripheral neuropathies. Over the 4-year retrospective period, 93 consecutive patients underwent abdominal free flap breast reconstruction, six of whom (6.5%) developed a peripheral neuropathy. Following the introduction of the new positioning protocol, prospective data collected on 65 consecutive patients showed no further occurrences of perioperative neuropathy (p = 0.04). There were no significant differences in the characteristics between the two cohorts. Perioperative peripheral neuropathy in abdominal free flap breast reconstruction is a preventable problem. This paper presents a peripheral neuropathy prevention protocol for managing these patients.

A STUDY ESTABLISHING THE IMPORTANCE OF BODY COMPOSITION ANALYSIS, REGULAR PHYSIOTHERAPY AND DIETARY MODIFICATIONS FOR INDEPENDENT AND HEALTHY LIVING AMONG GERIATRIC POPULATION: A DETAILED SYSTEMATIC REVIEW ARTICLE

Background: This systematic review article aims towards comprehensive and elaborative collection of research articles related to the importance of body composition analysis, Physiotherapy and nutrition for independent geriatric lifestyle. The review article includes articles which suggest the importance of Body composition analysis, Physiotherapy interventions, specific exercises and a combination of fat free, fiber, fruit and fluid diet.Methods: A comprehensive electronic search was conducted using electronic databases Pub Med, MEDLINE, Google Scholar, Science Direct, Research gate, ICMJE, DOAJ, DRJI, IOSR, WAME and many others. In Total 3714, Research papers were reviewed which reported, Age ≥50 years, changes in Body composition in elderly , effects of Diet &Exercises on Body composition and effects of regular Physiotherapy in Geriatric health and obesity. Literature search was restricted to the studies conducted during 1980-2015.Results: Finally 55 papers along with references in research proposal were included. Review shows that ageing, body composition, Physiotherapeutic intervention and nutrition play an interdependent role in providing independent and healthy living among geriatric population.Conclusion: Combined and comprehensive interventions in form of periodic Body Composition Analysis, Physiotherapy interventions with Exercise therapy sessions and Nutritional Supplementation, will be more effective in combating ageing and independent healthy living among Geriatric population. Finally with this review we shall conclude that achieving perfect geriatric health depends upon awareness among the geriatric community to periodically analyze their body composition and regularly comply with exercise therapy sessions, subjective Physiotherapy modality sessions and nutritional supplementation. These principles help in achieving physically fit, healthy, happy and independent geriatric Community.

Age of independent sitting posture acquisition for children with myelomeningocele

Objective: To study the acquisition of independent sitting posture in patients with high lumbar and thoracic myelomeningocele (MMC). Method: Cross-sectional study in children aged between 6 months and 4 years with MMC. A research was done in medical records and report cards from children being followed in the physical therapy sector at Fernandes Figueira Institute (IFF), Rio de Janeiro, RJ, Brazil. Results: The sample comprised 16 children with MMC, 9 (56%) female and 7 (43%) male, 13 (81.2%) children with high lumbar level, and 3 (18.8%) with thoracic level. In relation to independent sitting posture, 13 (81.2%) achieved this objective. The average time to reach this posture was 16 months (9-31). The average time of physiotherapeutic following was 3 months (1-8). Among the 13 children who sat, 2 (15.4%) were thoracic and 11 (84.6%) high lumbar level cases. Most (15 – 93.8%) performed regular physical therapy. The average age to start treatment was 3 months (1-8). Conclusion: It was observed that the largest part of the sample acquired independent sitting posture, including the thoracic level cases that reached this goal in a younger age than the found in the literature. The results can be considered positive, reinforcing the early physiotherapeutic intervention for the acquisition of motor development, promotion of functionality, and improvement of quality of life of children with MMC.

Evaluation of the patient education program “Live his spondyloarthrtis” from January, 2007 till May, 2014

Medical care of ankylosing spondylarthritis combines medications, rehabilitation, and patient's education. Prospective evaluation of the impact of a patient's education program dedicated to patients affected by ankylosing spondylarthritis. One hundred and eighty-six patients were involved in this program between 2007 and 2014. They underwent a mean of 25 sessions of multidisciplinary education. A complete team including physiotherapists, occupational therapists, nurses, dietetitians, chiropodists, psychiatrists, physical medicine and rehabilitation doctors, and rheumatologists conducted this program. It included teaching of auto-exercises by physiotherapists and occupational therapists, relaxation, balneotherapy, gymnastics, information on the disease and its care, including prevention of complications and management of treatment. One hundred and forty-five patients (78%) completed the follow-up 6 months after the program. The average age of the patients is 42 years [17–78 years], 51% were men. Seventy percent carried the gene HLA B27. The disease evolved for 13.6 years with a delay diagnostic of 8 years. 62% of the patients had a professional activity, 19% were in incapacity. Sixty-two percent were taking non steroidal anti-inflammatory drugs, 45% were under anti TNF treatment. Among the patients under anti TNF, 84% made lonely their own injections. 44% underwent regular physiotherapy, 15% practised self-rehabilitation. At the end of the program and at 6 months, 100% of the patients reported that the program met their needs and expectations. At 6 months, an improvement of the following parameters were observed: BASDAI 0.93 [5.4; 4.1] with P < 0.001, BASFI 0.72 [7.41; 4] with P < 0.011, EVA disease-1.01 [7; 4] with P = 0.011, EVA pain-0.84 [8.4; 4] with P = 0.012, stiffness 14.17 [180; 120] with P < 0.001, count of pain joints 0.8 [31; 4] with P = 0.011. An improvement was also noted concerning cervical mobilities and knowledge of the disease. Our original program includes a physical and educational care of ankylosing spondylarthritis patients. It reaches initial goals to improve the quality of life of the patients.

Comparison between active cycles of breathing with postural drainage versus conventional chest physiotherapy in subjects with bronchiectasis

IntroductionBronchiectasis is a chronic debilitating condition with abnormal permanent dilatation of the airways causing impaired mucus clearance, despite regular chest physiotherapy being mainstay of management for bronchiectasis, there is little evidence supporting regular chest physiotherapy in bronchiectasis which aims to mobilize secretions and facilitate effective expectoration, providing control of cough and improving airway clearance. The objective of this study was to compare between the efficacy of 2 techniques of chest physiotherapy ACBT with postural drainage and conventional chest physical therapy as a method of airway clearance in adults with productive bronchiectasis. MethodsThe study included 30 subjects, 20 males and 10 females; all having bronchiectasis, the study was carried out on October 6 at the University Hospital. The participating subjects underwent conventional chest physical therapy or ACBT following postural drainage as the airway clearance technique in random order on 14 successive days with twice daily frequency. ResultsThere was a significant difference regarding mMRC before and after both ACBT and conventional physiotherapy, there was a significant improvement regarding FVC and MMEF after ACBT while there was a significant improvement of FEV1 and MMEF after conventional physiotherapy. As regards arterial blood gas data comparison, there were significant improvements regarding PaCO2, PaO2 and PAO2 while there was no significant difference as regards P (A-a) O2 after both types of physiotherapy techniques. Comparison between the 2 groups regarding mMRC dyspnea score, spirometry, arterial blood gas data, Leicester cough questionnaire (LCQ) and sputum wet volume before starting physiotherapy shows no significant difference while there were significant differences in advance to post ACBT physiotherapy sessions as regards PaO2, P (A-a) O2 gradient, LCQ (physical domain score and total score) and sputum wet volume. ConclusionACBT with postural drainage is found to be more effective than conventional chest physical therapy management of bronchiectasis during infective exacerbation.

Recovery from total knee arthroplasty through continuous passive motion

The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

Recuperación de la artroplastia de rodilla a través de la movilización pasiva continua

The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

Decreased physical activity is associated with an increased incidence or progression of peripheral artery disease in hemodialysis patients

Background:Hemodialysis patients are at a higher risk of developing peripheral artery disease (PAD) than the general population. However, factors associatedwith the incidence or progression of PAD in hemodialysis patients have not been fully elucidated. Furthermore, very few studies have assessed the associationbetween the development of PADandphysical activity levels, although most of hemodialysis patients have low levels of daily physical activity and are thus prone to arteriosclerosis. Purpose: The purpose of this study was to examine whether physical activity levels contribute to the development of PAD in hemodialysis patients using multivariate analyses adjusted for clinical variables. Methods: This prospective study followed Japanese outpatients undergoing maintenance hemodialysis three times a week at the Hemodialysis Center from July 2012 to January 2013 for one year. Patients who had been treated with percutaneous transluminal angioplasty and/or stenting, had an ankle-brachial index (ABI) ≥1.40 at baseline, had noncompliance with prescribed medications (antiplatelet and statin drugs), and showed changes in physical activity levels during the observation period due to adverse clinical events were excluded. Age, sex, body mass index, dialysis vintage, history of smoking, comorbid conditions, blood biochemical data (creatinine, calcium-phosphate products, low and high-density lipoprotein cholesterol, triglyceride, and intact parathyroid hormone), levels (high or low) of physical activity, and ABI were obtained from clinical records at baseline. Patients were classified as having a low physical activity level if they used wheelchair at home/hospital, required walking assistance, or had limited ambulation at/around home. For analysis, patients were divided into groups with or without newly diagnosed PAD (ABI ≥1.00 at baseline and ABI ≤0.99 at the endpoint), and with or without progressive PAD (ABI ≤0.99 at baseline and subsequent decrease in ABI to ≥0.10) according to changes in ABI during the study period. Multivariate logistic regression analyses adjusted for baseline clinical variables were performed to identify the prognostic effect of physical activity levels on PAD incidence or progression after one year. Analysis was performed using the Statistical Package for Social Sciences (SPSS version 21, USA). Results: A total of 124 eligible Japanese outpatients (mean age, 65.7± 10.7; male, 52.4%; mean hemodialysis vintage, 9.9± 8.6 years) were included in the study. During the follow-up period, 13 hemodialysis patients (10.5%) were newly diagnosed or had progressive PAD. Adjusted multivariate logistic regression analyses revealed a significant association between PAD incidence or progression and physical activity levels (odds ratio, 5.504; 95% confidence interval, 1.653–18.326; P= 0.005). Conclusion(s):Decreased physical activity is closely and independently associated with an increased incidence or progression of PAD in hemodialysis patients. Implications: Hemodialysis patients reportedly have significantly lower physical activity levels compared to age-matched community-dwelling people. Regular physical therapy to increase habitual physical activity should be considered as an effective approach to prevent the development of PAD in clinically stable hemodialysis patients.

Treadmill gait training combined with functional electrical stimulation on hip abductor and ankle dorsiflexor muscles for chronic hemiparesis

The purpose of this study was to investigate the effects of treadmill training (TT) with functional electrical stimulation (FES) applied to the gluteus medius (GM) and tibialis anterior (TA) muscles on gait and balance performance in individuals with chronic hemiparetic stroke. Thirty-six participants with chronic hemiparesis were recruited to this study and randomly distributed into three groups: TT with FES applied to the GM and TA muscles (TTFES-GM+TA group, 12 patients); TT with FES applied to the TA muscle (TTFES-TA group, 12 patients); and TT only (control group, 12 patients). All participants underwent 20 sessions of TT with a harness (30min five times per week for 4 weeks). They also received regular physical therapy for 1h five times per week for 4 weeks. All participants were assessed before and after training using digital muscle testing, the Medical Research Council (MRC) scale, the 6-min walk test (6MWT), and spatiotemporal parameters. After training, the TTFES-GM+TA group showed significant improvement in hip abductor strength, Berg Balance Scale score, 6MWT result, MRC scale score grade, gait velocity, and cadence compared to the TTFES-TA group and control group. These findings show that TT with FES applied to the GM and TA muscles increased lower limb muscle strength and improved balance and gait capacities. Therefore, TT with FES applied to the GM and TA could be a beneficial intervention in clinical settings for individuals with chronic hemiparetic stroke.

Obstetric Fistula and Common Peroneal Nerve Palsy in a Rural Based Women: A Case Report

Neglected obstructed labor is a major cause of both maternal and newborn morbidity and mortality. By far the most severe and distressing long term morbidity following obstructed labor is obstetric fistula i.e. Vesicovaginal fistula. In developing countries fistula is commonly the result of prolonged obstructed labor. A18 year old primi gravida was admitted in the labor ward with the involuntary passage of stool and urine and unable to walk after 15 days of her home delivery. Temporary colostomy was done. Patient was on regular physiotherapy for prolonged time and she was responded slowly. There was a plan for repair of Vesicovaginal and Rectovaginal fistula. Obstructed labor complex is completely preventable if high quality basic and comprehensive health services are available to all. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22891 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 71-73

The Effectiveness of the Functional Magnetic Stimulation Therapy in Treating Sciatica Syndrome

Introduction: Degenerative or traumatic causes are most common in generating sciatica syndrome, which is normally treated with well-known physical therapy methods. A relatively new way of treating sciatica problems is so-called functional magnetic stimulation (FMS), whose principle is based on electromagnetic field inducing electrical field inside the body. Electrical field triggers action potential of nerve cells and that way stimulates peripheral motor nerve system. Aim: Aim of this study is to measure and estimate the effectiveness of implementing therapy with functional magnetic stimulation in regular physical treatment of sciatica syndrome. Materials and Methods: 28 male patients aged between 30 and 55 with back problem were recruited on an outpatient basis. FMS therapy was performed with TESLA Stym? device (Iskra Medical d.o.o., Slovenia) treating lumbosacral region equally on both sides of the spine. Physical examination was performed to evaluate tree parameters: the mobility of the lumbar spine in flexion and extension, together with the straight leg raise test (Lasegue sign). We estimated patients’ progress, comparing angle values of mobility from the first examination day with other examination days. Results: In FMS treated group of patients, lumbosacral flexion, extension and Lasegue test angle were significantly higher compared to day 0 on the first physical examination day (day 3) (p < 0.05). In control group such increase of a measured angle was not noticed until a second physical examination day (day 5) or a third physical examination day (day 8) (p < 0.05). Discussion: Results in this study showed that applying FMS therapy along with other standard physical therapy methods rapidly increased effectiveness of the treatment of sciatica syndrome (lat. ischialgia). It suggests that functional magnetic therapy could be suggested as a regular physical therapy method in treating this kind of pain syndromes.

Osteomyelitis with a twist: Streptococcus pneumoniae causing sternoclavicular septic arthritis.

CASE PRESENTATION An 80-year-old woman of Caribbean descent with a history of type 2 diabetes mellitus, gout, osteoarthritis, gastrointestinal reflux and atrial fibrillation, presented with a 12 h history of left-sided shoulder, neck and back pain. Her temperature was 38.0°C and her white blood cell count was 15×109 cells/L. She experienced tenderness in the left sternoclavicular and sternomanubrial regions associated with warmth and erythema, but without an effusion. Her neck range of motion was restricted by pain on the left side, including neck deviation to the right, which was compatible with torticollis. She could not abduct her shoulder beyond 60 degrees. She had a III/VI systolic ejection murmur at the left upper sternal border, but no stigmata of infectious endocarditis. Her gastrointestinal, dermatological and respiratory examinations were within normal limits. On admission, she was empirically started on ceftriaxone for suspected shoulder joint septic arthritis. An unsuccessful attempt was made to aspirate the left shoulder joint. The pain progressed toward her anterior chest wall and within 72 h C-reactive protein levels had increased from 11 mg/L to 240 mg/L. Blood cultures were positive in three of three sets for penicillin-susceptible Streptococcus pneumoniae. Aspiration of the sternoclavicular joint (SCJ) was unsuccessful. Transesophageal echocardiography did not reveal evidence of endocarditis. The chest radiograph did not reveal evidence of pneumonia. Despite prolonged antibiotic therapy, the patient never experienced full recovery of function, primarily with respect to arm adduction, which was limited by pain at the SCJ. Repeat computed tomography (CT) scan after therapy revealed arthritic changes related to her treated infection. Avoidance of pain led to the patient’s torticollis, which was the most distressing clinical feature for her. This persisted for months despite regular physiotherapy sessions.

The trainees’ pain with laparoscopic surgery: what do trainees really know about theatre set-up and how this impacts their health

Although it is clear that laparoscopic surgery is beneficial to the patient, such surgery brings with it unique challenges and possible injury to the surgeon. Firstly, we sought to investigate the prevalence of musculoskeletal distress experienced by trainees. Secondly, we sought to ascertain if the trainees had received appropriate instruction to optimise their operative environment during laparoscopic surgery. An anonymised questionnaire survey was distributed to all 89 trainees in obstetrics and gynaecology within Northern Ireland. Forty-four (83 %) trainees reported to having received formal instruction in theatre layout and operating body position. However, only 8 (15 %) were aware of the ideal operating surface height, and 6 (11 %) knew the ideal monitor position, while 11 (20 %) and 7 (13 %) knew the correct angles for grasping and suturing tissue, respectively. Eighty-five percent of trainees suffered some form of musculoskeletal distress with back, shoulder and neck pain the most common areas affected. Eyestrain was reported by 1/3 of trainees. Although no trainees required sick leave, one in three required regular analgesia, physiotherapy or alternative therapies. It is clear that current training has not addressed operating ergonomics sufficiently, and this is having a significant impact on trainees’ health.

Gait Cycle Analysis

Video-assisted gait kinetics analysis has been a sensitive method to assess rat sciatic nerve function after injury and repair. However, in conduit repair of sciatic nerve defects, previously reported kinematic measurements failed to be a sensitive indicator because of the inferior recovery and inevitable joint contracture. This study aimed to explore the role of physiotherapy in mitigating joint contracture and to seek motion analysis indices that can sensitively reflect motor function. Data were collected from 26 rats that underwent sciatic nerve transection and conduit repair. Regular postoperative physiotherapy was applied. Parameters regarding step length, phase duration, and ankle angle were acquired and analyzed from video recording of gait kinetics preoperatively and at regular postoperative intervals. Stride length ratio (step length of uninjured foot/step length of injured foot), percent swing of the normal paw (percentage of the total stride duration when the uninjured paw is in the air), propulsion angle (toe-off angle subtracted by midstance angle), and clearance angle (ankle angle change from toe off to midswing) decreased postoperatively comparing with baseline values. The gradual recovery of these measurements had a strong correlation with the post-nerve repair time course. Ankle joint contracture persisted despite rigorous physiotherapy. Parameters acquired from a 2-dimensional motion analysis system, that is, stride length ratio, percent swing of the normal paw, propulsion angle, and clearance angle, could sensitively reflect nerve function impairment and recovery in the rat sciatic nerve conduit repair model despite the existence of joint contractures.

Idiopathic Facial Paralysis (Bell’s palsy)

Bell’s palsy is defined as a neuropathy of the peripheral seventh cranial nerve or the facial nerve. It is usually from an idiopathic cause but it can result from traumatic, compressive, infective, inflammatory or metabolic abnormalities involving the facial nerve. Bell’s palsy is more common in adults than in children. We present a case of Bell’s palsy in an 38-year-old women who completely recovered after treatment with oral antiviral agents and steroids followed by regular facial physiotherapy. The dilemma in management of Bell’s palsy with a review of relevant literature is discussed in this report.