ROM Exercise Research Articles

PEMBERIAN ROM AKTIF TERHADAP TINGKAT KEMAMPUAN ADL DASAR PADA PASIEN POST OPERASI FRAKTUR EKSTREMITAS BAWAH DENGAN TINDAKAN ORIF DI RSUD DR. ZAINOEL ABIDIN BANDA ACEH

Based on data from the WHO, in 2013 there were 1.3 million people suffering from fractures due to traffic accidents. Fracture patients have limitations in carrying out their daily activities and active ROM exercises need to be done. The purpose of the study was to determine the effect of giving active ROM on the level of basic ADL ability in postoperative lower extremity fracture patients with ORIF action at RSUDZA Banda Aceh in 2018. The research design used in this study was Quasi Experiment with Static Group Comparison, Sampling in this study conducted by purposive sampling technique totaling 20 respondents. Data was collected using the basic ADL observation sheet. The results showed that the basic ADL ability scores in the intervention group were mostly in the mild dependency category, as much as 60%, while in the control group many were in the moderate dependency category, as much as 40%. Basic ADL in postoperative lower extremity fracture patients with ORIF action in Raudhah 6 and Raudhah 7 RSUDZA Banda Aceh (p = 0.008) which means Ha is accepted and H0 is rejected. The importance of doing active ROM for postoperative lower extremity fracture patients with ORIF action to help the healing process. It is hoped that nurses will provide an explanation of active ROM exercises as a permanent activity in an effort to prevent loss of body function abilities.

Development of DVT in an operated case of cemented bipolar hemiarthroplasty during COVID pandemic: a case report

<p class="abstract">One of the most common treatment for fracture neck of femur in the elderly is bipolar hemi-arthroplasty which is associated with the patient being mobilized early, lower complication rate, longer implant life. Both uncemented and cemented arthroplasty have been associated with good outcomes, however cemented arthroplasty has higher incidences of DVT due to the thrombogenic potential of cement in addition to the hypercoagulability due to the femoral fracture. Hence, DVT remains a life-threatening complication of arthroplasty, despite the preventive measures owing also to certain genetic and acquired risk factors. We have a 70-year-old female patient, who presented to us with a post traumatic right sided displaced neck of femur with greater trochanter fracture following an alleged history of slip and fall at home who was operated with cemented bipolar hemi-arthroplasty. The patient developed deep vein thrombosis of the operated limb even after adequate mobilization with full weight bearing over the operated limb from post op day 2 and other adequate physiotherapy exercises such as hip/knee ROM exercises and ankle pump exercises. Although, our case report seems to be too far-fetched in terms of correlating this episode of DVT even after adequate mobilization from POD-2 to the ongoing COVID-19 pandemic causing a sub-clinical asymptomatic coronavirus infection causing an increased hypercoagulability of the blood as has been demonstrated by various studies, it does provide substantial evidence which warrants wider multi-centric studies in order to provide a definite correlation of the aforementioned scenario. </p>

COMPARISION OF MAITLAND MOBILIZATION AND MUSCLE ENERGY TECHNIQUE ON PAIN, RANGE OF MOTION AND FUNCTIONS IN ADHESIVE CAPSULITIS

The adhesive capsulitis (frozen shoulder) a well-known musculoskeletal problem that affects more women and diabetic population. The restriction is in capsular pattern used to limit the daily activities of the population. Objective: To study the effectiveness of Muscle energy technique and Maitland mobilization technique on the pain, range of motion and disability index in the patients with adhesive capsulitis. Method and subjects: This quasi-experimental study consists of 30 subjects including both males and females between 40-60 years, already diagnosed with adhesive capsulitis were selected. The sample was collected using a nonprobability convenient sampling method and was assigned groups (A or B) with 15 subjects each. Group A received a moist pack for 15 minutes, active ROM exercises, and Muscle Energy Technique (MET). Group B received a moist pack for 15 minutes, active ROM exercises, and Maitland mobilization. Both the groups were treated 2 times a week for 2 weeks and were told to continue the exercises at home. All the subjects were measured for pain and disability by SPADI, and ROM using a goniometer on 1st day on the 15th day after treatment. Result: There were 20 (66.6%) male and 10(33.4%) female participants. There was significant improvement at post-treatment levels in pain and ROM and SPADI in both groups. Although ROM improvement and pain reduction was improved in both groups but statistically significant (p<0.05) between group shown Maitland was superior to MET. Conclusion: Maitland Mobilization is more effective in reducing pain and increasing function and Disability among the patients having Adhesive Capsulitis as compared to MET for Pain, ROM and shoulder functions.

IMPACT OF TREADMILL RUNNING ON BLOOD GLUCOSE LEVEL OF TYPE 2 DIABETES MELLITUS PATIENTS IN GHURKI TRUST AND TEACHING HOSPITAL

Type 2 diabetes mellitus were define by WHO (world health organization) that “It is a metabolic syndrome which is characterized by prolonged increase in blood glucose level due to any abnormality in insulin action or release of insulin. It is also known as noninsulin dependent diabetes mellitus (NIDDM)”According to American diabetic Association (ADA) in 2004, the symptoms of long term increase glucose level in blood includes frequent urination, increase thirst, excessive hunger and blurry sight. Methodos: Quasi Experimental study design without control group,the duration for the study was 4 months.The study was conducted at Physiotherapy Department, Ghurki trust and teaching hospital. Blood glucose level, Glucose meter and treadmill runningwere outcome measures. Convenient sampling technique was used, 42 subjects were included in study. They were recruited from Ghurki Trust and Teaching Hospital. Diagnosed patients of diabetes mellitus type 2 were eligible. Patients, who fulfil the inclusion criteria, were interviewed and examined by the diabetic clinician in Ghurki trust and teaching hospital. By using convenient sampling method the subject was selected to perform the task. The experimental procedure last for half an hour includes 5 minutes warm up 20 minutes treadmill run and 5 minutes of cool down. In warm up and cool down period mild stretching exercise, active ROM and breathing exercise for 5 minutes Selected Individuals was run on treadmill at a speed of 8km/hour (5miles per hour) for 20 minutes after doing warm up exercise. Conclusion: The aerobic exercise intervention is an effective tool to control the noninsulin dependent diabetes mellitus as it lower the blood glucose level but exercise must be performed regularly to have good results. Most of the patients with controlled diabetes are able to perform aerobic exercise safely as long as some precautionary measure is taken. Increase physical activity is a key for good health in patients with type 2 diabetes

Upper Crossed Syndrome: Trends and Recent Advances in the Physiotherapy Treatment a Narrative Review

Background: How does it affect the quality of life of the patient?
 Upper Crossed Syndrome (UCS) is also discussed as proximal or shoulder crossed syndrome. According to Vladimir Janda, UCS is characterized by the tightness of the levator scapulae muscle, upper trapezius muscle, on dorsal sides crosses with tightness of pectoralis major muscle and minor muscle. Weakness of the deep cervical flexors ventrally crosses along with weakness of the middle and the lower trapezius. The weakness and tightness lead to postural imbalance. In addition to this, it creates postural patterning of rounded shoulder forward head posture, loss of cervical lordosis, and increased kyphosis. These can lead to postural adjustment in the upper quarter of the body.
 Materials and Methods: Out of 17 articles screened 8 studies are included in this review according to the inclusion and exclusion criteria. The inclusion criteria are forward head posture, articles from the year 2011 to 2021, patient age between 20-50 years, article published in English languages, articles available in full text, and RCT’S. The exclusion criteria are, articles published before 2011, age less than 20 years and more than 50 years old, articles published other than English language, and articles not available with full text. Relevant studies were retrieved through Cochrane, PubMed, CINHAL, and Embase databases from the year 2011 to 2021.
 Results: All the physiotherapeutic treatments including conventional and recent trends showed a beneficial effect on patient with upper crossed syndrome or postural abnormalities.
 Conclusion: All physiotherapy interventions like strengthening and stretching, resistance exercises, postural correction exercises, and ROM exercises has a positive effect on the prevention and treatment of upper crossed syndrome. Also, recent trends like dry needling, yoga therapy, myofascial trigger release, eccentric muscle energy technique, Kinesio taping, and IFT and EMG activity has also shown positive result in UCS.

Guillain Barre Syndrome in Children : Case Report

Background: The incidence of GBS at the age of <15 years is 1.5 cases per 100,000 population and peaks at the age of 70-79 years, reaching 8.6 cases per 100,000 population. The peak of this disease at the age of 15-35 years and 50-75 years. Infants are said to have the lowest risk of developing GBS. Male have 1.5 times greater risk than female Case: a 7 years old male children was presented with main complaint of weakness at extrimites on both side since March 27th, 2019. Patient felt weakness at lower extremities first and then followed by upper extremities two days later. patient cannot use his hand and leg at all. patient was unable to transfer from lying to sitting independently and unable to slide his buttocks. patient felt numbness on his both arms and leg. patient got dyspepsia one week before weakness. Based on physical and diagnostic examination patient diagnosed with Tetraparesis LMN type due to Guillan Barre Syndrome (GBS). Patient got rehabilitation program consist of NMES, ROM, active breathing, endurance, strengthening, transfer and mobilization exercise, and occupational therapy. Patient got improvement in muscle power of upper and lower extremities after five (5) month rehabilitation medicines. Barthel index improved from 25 to 95 and activity daily living independently. Conclusion: NMES, ROM, active breathing, endurance, strengthening, transfer and mobilization exercise, and occupational therapy can improve muscle power of upper and lower extremities for GBS of male children in five month rehabilitation program.

Case Report on Rom Exercises Effective in Reducing Pain and Discomfort in Hodgkin’s Lymphoma

Introduction: Hodgkin lymphoma, which also accounts up 11% of all lymphomas, is named Hodgkin's disease. This malignant disease is known as the Reed-Sternberg-cell, which is situated in lymph-nodes and is characterized by the proliferation of irregular gait. The disease occurs more often in those between 15-30 years and over 55 and is doubling prevalent in women, in men and women. The sickness is bimodal age specific. The frequency in India is around 1 in 25,000 inhabitants. However, for all stages, long-term survival is around 80%.&#x0D; Clinical Findings: The onset of symptoms is usually insidious but usually used for frequent diagnosis are: Extension of lymph nodes in area of cervical, axillary or inguinal, extraordinary weight loss, Fatigue, Weakness, fever, chills, tachycardia, sweating or nocturnal sweat.&#x0D; Diagnostic Evaluation: Peripheral analysis of the blood, Biopsy of Excision of lymph node, Examination of bone marrow, Radiological study&#x0D; Therapeutic Management: Chemotherapy and radiation therapy or some may need immunotherapy or stem cell transplant.&#x0D; Outcome: After treatment, the child showed great improvement.&#x0D; Conclusion: A 11 year male child was admitted to pediatric ward no.22 in AVBRH on 25/05/2021 with a unique case of Hodgkin’s lymphoma with severe pain and discompfort. He was admitted in hospital and all investigation and treatment were started. After getting medical treatment and physiotherapy he shows great improvement and the treatment was still going on till my last date of care.

Current Consensus for Rehabilitation Protocols of the Surgically Repaired Acute Mid-Substance Achilles Rupture: A Systematic Review and Recommendations From the “GAIT” Study Group

Surgical repair of acute mid-substance Achilles tendon ruptures is performed in active patients, but the postoperative rehabilitation program is often based on the experience of the surgeon or therapist, rather than on evidence-based protocols. The aim of the study is to establish an evidence-based protocol for rehabilitation. This study is a consensus statement. The “GAIT” study group (German, American, and Italian Tendon), an informal collection of 4 experienced foot and ankle surgeons, met to address the question of what items they felt were important relative to rehabilitate a surgically repaired Achilles tendon acute rupture. Thirty-three statements were formulated. A value of 100% agreement by all the members was set to produce a proposed consensus statement. A value of 80% consensus was set to produce “strong recommendation.” A systematic review of the literature was also performed. The GAIT group reach 100% agreement on the average postoperative non-weightbearing for 2.3 weeks, the foot in plantarflexion for the first 4 weeks, avoiding ROM exercises beyond neutral, and both stretching and eccentric exercise, not started before 12 weeks. Concentric bilateral heel raises should be performed after 6 weeks, and the average return to initiate sports, was 24.4 weeks. The use of a 1/8th-1/4th inch heel cushions in daily shoes after 8 weeks, the use of an antigravity treadmill for rehabilitation, and the return to sports based on heel raise repetitions is strongly recommended. Given lack of established verified protocols, the recommendations by our experienced panel should be considered. These proposed consensus statements could be used as a basis for larger controlled trials, and develop best practices.

PHYSIOTHERAPY REHABILITATION OF 3-YEAR-OLD GIRL HAVING SPASTIC DIPLEGIC CEREBRAL PALSY

Cerebral palsy is a concept that denotes a collection of long-term motion and posture disturbances that hinder daily tasks. The incidence has been estimated to be between 2 and 2.5 per 1000 live births. Non-progressive reforms with in brain's progress across foetal or child advancement are viewed as evidence of this disorders. Cerebral palsy can be segregated into certain sorts of motor impediments relying on their topography: Diplegia, hemiplegia, quadriplegia, monoplegia, and triplegia. Such patients seemed to have cognitive, sensory, or motor illness. It has an effect on motion, posture, and physical activity as well. Supplemental abnormalities such as spasticity, which have an effect on general health and makes studying fresh chores distressing, are also prevalent in children with CP. Spasticity is a pervasive feature of a CNS lesion. This leads to issues with functionality. Medical surgical and physiotherapeutic approaches such as stretching, positioning, manual therapies such as massage, MFR, MET and Cryotherapy are also used along with a few other physiotherapy approaches to alleviate spasticity. MFR and cryotherapy have been shown to help children with CP counteract spasticity. The objective of this project is to focus on the perks of physiotherapy restoration in cerebral palsy, along with the influences of MFR and cryotherapy on spasticity in the limbs in a 3-year-old girl with spastic diplegic cerebral palsy. The key concerns of the patient were hurdle in rolling and crawling, failure to stand and sit without aid, and spasticity. When the assessment was performed using GMFCS and spasticity by MAS and MTS, the diagnosis of spastic diplegic cerebral palsy was ascertained. It has been claimed that physiotherapy care is viable in fulfilling intended outcomes. The following are the outcomes: Cryotherapy and Myofascial Release technique were used to manage spasticity, as well as ROM exercises, gradual passive stretching, balance training, swiss ball exercises, weight bearing exercises, orthosis, and a decent home fitness regimen. The analysis revealed that physiotherapy measures like those of cryotherapy and myofascial release technique had a promising effect on improving spasticity and raising ability to stand, roll, partial neck control, crawl, balance posture, and stand with AFO help.

Peran Pemberian Terapi Latihan Pasca Operasi Total Knee Arthroplasty pada Kasus Osteoarthritis : Artikel Review

Introduction: Damage to cartilage can be caused by various factors, the most common of which is osteoarthritis. Total Knee Arthroplasty (TKA) is a surgical procedure applied to replace the knee joint area using fixed bearing implants. This surgery has a high success rate and can improve knee function and quality of life. Objective: to examine the role of physiotherapy in reducing the risk of TKA complications such as pain, swelling and decreased motor function. Methods: literature review by searching the website of the National Center for Biotechnology Information. Results: Exercise therapy interventions that can be used for TKA include ROM exercises, stretching exercises, strengthening exercise, stability exercise, balance exercise, and functional exercises. Conclusion: The role of physiotherapy by providing exercise therapy in post-TKA can be useful to reduce pain and improve function, movement and quality of life.

Acute Achilles tendon ruptures: Surgical versus non-surgical treatment using early functional rehabilitation: A randomized controlled study

Patients were randomized to surgical or non-surgical treatment for acute Achilles tendon rupture. All patients in both the groups underwent functional [bracing] treatment that includes early weight bearing and early range of motion exercises. The primary outcomes included calf circumference, range of motion, calf muscle strength and functional evaluation by Achilles tendon total rupture [ATRS] score at 6 and 12 months after injury. The secondary outcome is re-rupture rates and other complications.Results: A total of 30 patients [15 patients treated operatively and 15 patients treated non-operatively] were randomized. There were 19 men and 11 women. Mean age 49.5 ± 11.5 years. Re-ruptures occurred in 1 patient [7%] in the surgical group and 2 patients [13%] in the non-surgical group [P=0.368]. The mean ATRS Score at 6 months and 12 months was 74 and 86 in the surgical group and 69 and 84 in the non-surgical group respectively. There was no statistically significant difference between 2 groups with regard to calf circumference ROM, Plantar flexion strength and ATRS Score [p=0.713, p=0.412]. More complications occurred in the operative group, mainly related to wound and soft tissues, compared to non-operative group [15 vs 8].Conclusion: The results of this study demonstrates no significant differences between operative and non-operative functional treatment with regard to re-rupture rates and functional results. Early weight bearing and early ROM exercises are beneficial whether treated by surgical or non-surgical treatment. Addition of functional [Brace] rehabilitation to non-operative treatment avoids wound complications associated with surgery and is a valid alternative to surgical treatment.

IMPACT OF PHYSIOTHERAPY REHABILITATION ON HAND FUNCTION IN POST COLLE’S FRACTURE

Distal radius fractures are the most common types of fractures commonly occurring in pediatric and elderly populations but still have a significant impact on the health and well-being of young adults. Colle’s fracture of the wrist is among the most common bony injuries encountered in emergency practice commonly caused by a fall, landing on an outstretched hand with the wrist in dorsiflexion. The majority of Colle’s fractures are manageable with casting and conservative management. After healing and cast removal, the joint undergoes stiffness that needs prompt physiotherapy management to improve range of motion with muscle and ligament strengthening specifically for the injured hand and wrist affected. The patient’s main concerns were Pain, swelling, and stiffness over the forearm, wrist, and hand. The main clinical findings were pain, reduced ROM, reduced strength, stiffness and inability to perform wrist, and hand movements. Wrist and hand stiffness post Colle’s fracture. Physical therapy rehabilitation has already been proven effective in post-fracture rehabilitation, it includes protocol-based and evidence-based approach involving ROM exercises, stretching and strengthening exercises, mobilization, application of different modalities for symptomatic control, massage therapy, etc. outcomes are gross improvement in ROM, strength on MRC, improvement in the overall function of hand and activities of daily living as per Michigan hand outcome questionnaire, improvement in dexterity as per Jebsen hand dexterity test. Efficacy of physiotherapy rehabilitation has already been established. Early, programmed, evidence, and protocol-based rehabilitation has been found effective in reducing symptoms, improving functional independence, and ability to perform activities of daily living. The study also signifies how avoidance and ignorance can lead to complications that are otherwise preventable.

The functional and radiological outcome of open reduction and internal fixation of comminuted intra-articular distal humerus fracture with bi-columnar plating technique in adults

Recent studies have emphasised the importance of surgical approach, anatomical reconstruction, rigid fixation and early rehabilitation for good outcome. Hence the present study was planned to evaluate the outcome of surgical treatment of comminuted intra-articular distal humerus fractures fixed with bi-columnar plating technique. All the fractures were fixed using the AO bi-columnar plating techniques with distal humerus locking plates or reconstruction plates, fifteen cases via olecranon osteotomy approach and seven fractures fixed by triceps reflecting anconeus pedicle (TRAP) approach. Physiotherapy was started from 1st post-op day with unprotected ROM exercises were allowed by 3rd week. Patients were followed up at 6 weeks, 3 months, 6 months interval. Clinical outcome was assessed using MEPI (Mayo Elbow Performance Index) score and radiologically assessed for reduction, alignment, fracture union, post traumatic arthritis, and heterotopic ossification. The mean MEPI score was 90.45 points (range, 0 to 100 points), indicating mild impairment. Radiological union was achieved in 18.18% of patients at one and half month intervals whereas 81.82% of patients had radiological union during third month with average time for union being 10.9 weeks. We conclude that open reduction internal fixation of comminuted intra-articular fractures of the distal humerus with bi-columnar plating technique is an effective procedure with an excellent outcome in 54.5%, good outcome in 27.3% and fair outcome in 18.2% of patients in most age groups according to MEPI scoring. Patients have a high level of satisfaction and the majority return to their previous level of activity.

Latihan ROM Pasif Unilateral dan Bilateral terhadap Peningkatan Kekuatan Otot Akibat Stroke Iskemik

This study aims to compare the effectiveness of unilateral ROM and bilateral ROM exercises to increase muscle strength in post-hospitalized clients with hemiparesis due to ischemic stroke. The research method used is a quasi experimental two group pre and post test design. The results showed that there was an effect of both groups on increasing muscle strength with a p-value of 0.000, in conclusion, bilateral ROM exercises had a higher impact on increasing muscle strength compared to unilateral ROM exercises.&#x0D; &#x0D; Keywords: Muscle Strength, Bilateral ROM, Unilateral ROM, Ischemic Stroke

Effect Of Active Cylindrical Exercise On The Grip Power In Stroke Patient

Stroke is one of the non-communicable diseases that is increasing in prevalence. One of the effects of stroke patients is weakness on one side of the body. Therefore stroke patients need rehabilitation which is fast and precise with the range of motion exercises joints; one of them is grip strength. The recommended exercise is the Active Range of Motion Cylindrical Grip. This study aimed to determine the effect of cylindrical grip on the gripping power in stroke ischemic patients. The method used is Pre-Experiment with pre and post-test one-group design. This research uses Purposive Sampling of as many as 16 ischemic stroke patients. Active Range of Motion Cylindrical Grip exercise given as much as two times a day in 10 minutes for four days. The analysis used is a nonparametric test of Wilcoxon. Results of non-parametric test analysis Wilcoxon obtained p-Value = 0.001 (α &lt;0.05). This value indicates a significant influence between the strength value grips. It is expected that health workers can apply Active Cylindrical Grip ROM exercise as an alternative to increasing the gripping power in ischemic stroke patients who experience weakness and can improve the quality and service of healing ischemic stroke.

Pengaruh edukasi Range of Motion (ROM) pasif terhadap pengetahuan sikap dan keterampilan keluarga dalam merawat pasien stroke

Stroke is the highest cause of disability. Stroke patients with paralysis need to do the ROM exercise regularly. Families of stroke patients need an enough knowledge in ordet to do the ROM exercise at home. The purpose of the study is to determine the effect of passive ROM education on families’ knowledge, attitudes and skills in stroke patients at the Klaten Islamic Hospital. This research was a quantitative type with a research design using a quasi-experiment with a pretest-posttest design with a control group. The population in this study were all stroke patients at Klaten Islamic Hospital with an average of 42 patients per month. The sampling technique used was total sampling. The samples were grouped, a total of 21 research respondents were included in the intervention group and there were 21 samples in the control group. The data research instrument used questionnaires and observation sheets to measure and observe the knowledge, attitudes and skills of the family in performing passive ROM on patients. Data analysis used Wilcoxon and Mann Whitney test. The results showed an increase in family knowledge, attitudes and skills about ROM both in the intervention group and the control group. The category of improvement towards the good category mostly occurred in the intervention group. In the intervention group, the results of the assessment showed that the majority of respondents with poor knowledge (71.4%) changed to be good (100%). The attitude of the respondents also increased, from the majority (72.6%) to be good (90.5%). And also on the skill variable, from the majority was less (81%) to be good (100%). The results of the different test showed that there was an effect of passive ROM education on knowledge, attitudes and skills with p value of 0.000. The conclusion obtained shows that there is an effect of passive ROM education on the knowledge, attitudes and skills of stroke patients' families in both the control and intervention groups.

Management of Physiotherapy In Brachial Plexus Injury Post Neurotization SAN To SSN : Case Report

Brachial plexus injury (BPI) is an injury to the brachial plexus that can cause muscle paralysis in the upper extremities. Based on the data, the proportion of brachial plexus injuries with total lesions (C5–T1) was 54%, partial lesions (C5-6) 24%, (C5-C7) 19%, and (C8-Th1) 3%. This case report aims to present the physiotherapy management of brachial plexus injury.&#x0D; A 23-year-old man with a medical diagnosis of brachial plexus injury. Previously the patient fell from the bathroom and suffered a blow to the shoulder and fractures in the proximal 1/3 of the ulna &amp; radial. The patient received the first medical treatment for fracture with ORIF (plate and screw), while the shoulder injury received medical treatment after 6 months. The medical procedure is SAN to SSN neurotization surgery.&#x0D; The physiotherapy program provided include ROM exercise, strengthening, stretching, and release. The results of the evaluation for 3 times of therapy showed that there was a change in passive ROM, pain, edema and spasm in the shoulder region. there has been no change in muscle strength and sensory function. In addition, in the wrist and elbow region there is an increase in muscle strength.&#x0D; The process of nerve recovery takes a long time, so there have not been many changes that have occurred in the patient. The process of nerve growth only occurs at 1 mm / day. Physiotherapy program given for 3 days postoperative conditions only aim to reduce problems such as muscle spasm, edema, postoperative pain, muscle tightness, and prevent potential problems that will occur.&#x0D; The physiotherapy program given can reduce secondary problems that occur in the condition 3 days after brachial plexus injury.

Pengelolaan Ketidakefektifan Perfusi Jaringan Perifer Pada Pasien Post ORIF Hari Ke-3 Atas Indikasi Fraktur Femur Dextra 1/3 Distal Di RSUD Ungaran

Fracture is the broken continuity of the bone. Based on type and size of the bone, bone can break when it is not strong enough to withstand the pressure applied to the bone. The purpose of this research was to determine the management of the ineffectiveness of peripheral tissue perfusion in Mrs.S suffering from third-day post ORIF with the indication of femur 1/3 distal dextra fracture in Cempaka room, Ungaran Regional Hospital. Management results obtained swollen femur on the third-day post ORIF. It can cause complications due to the ineffectiveness of peripheral tissue perfusion in the patient. A suggestion for nurses in the hospital is to be able to carry out routine observations in post-operative ORIF patients that might experience changing condition. Key words:ROM Exercise, Ineffective Peripheral Tissue Perfusion, Post ORIF

Effectiveness of Kaltenborn Posterior Glide and Coracohumeral Ligament Positional Stretching on External Rotation Range of Motion in Patients with Adhesive Capsulitis

Background:Adhesive capsulitis is a common and debilitating medical condition which is treated by varioussurgical and non-surgical treatments but there is no significant method universally. Physical therapists usevarious shoulder mobilization techniques to improve the ROM. Radiographic and surgical evidence presentstightened CHL to be a prime contributor to inadequate shoulder external rotation in individuals diagnosedwith adhesive capsulitis.Objective: To determine the combined effectiveness of Kaltenborn posterior glide and coracohumeralligament (CHL) positional stretching on external rotation in patients with adhesive capsulitis.Methods and Measures:A number of 30 subjects, both Male and Female with a primary diagnosis ofshoulder adhesive capsulitis by the physician were recruited. 15 subjects each were randomly assignedto Group-A(Experimental) and Group-B(control). All subjects received 6 therapy sessions consisting ofmoist heat, shoulder pendular and ROM exercises, Kaltenborn posterior glide and Coracohumeral ligamentpositional stretching in Group-A. Moist heat, shoulder pendular and ROM exercises in Group-B. Pre-testand post-test were carried out for both the groups and analysed using paired and independent t tests in anSPSS software.Results: The experimental group(Group-A) mean VAS score had decreased from 6.27 to 3.73, SPADI meanscore decreased from 0.534 to 0.380 and also Goniometer (Shoulder external ROM) showed an improvementfrom 29.2 to 35.33 but when intergroup analysis was done, it resulted in significance only for SPADI wherep &lt; 0.05. Through this measure, we can state that the treatment protocol for group A had a significantimprovement in disability but not much on pain and ROM in patients with adhesive capsulitis.Conclusion: All the interventions has brought about some improvement in each group post-treatment basedon the mean score but its significance vary. So, this study can be concluded that, the treatment protocol,Kaltenborn posterior glide and CHL positional stretching could bring a significant difference with regard todisabilty but not much of difference in pain and ROM in patients with adhesive capsulitis.

Is There a Disadvantage to Early Physical Therapy After Multiligament Surgery for Knee Dislocation? A Pilot Randomized Clinical Trial.

Multiligament knee injuries, though rare, can be profoundly disabling. Surgeons disagree about when to initiate rehabilitation after surgical reconstruction due to the conflicting priorities of postoperative stability and motion. (1) Does early or late initiation of physical therapy after multiligament knee surgery result in fewer postoperative manipulations? (2) Does early versus late physical therapy compromise stability postoperatively? (3) Does early initiation of physical therapy result in improved patient-reported outcomes, as measured by the Multi-ligament Quality of Life (ML-QOL) score? Between 2011 and 2016, 36 adults undergoing multiligament repair or reconstruction were prospectively enrolled in a randomized controlled trial and randomized 1:1 to either early rehabilitation or late rehabilitation after surgery. Eligibility included those with an injury to the posterior cruciate ligament (PCL) and at least one other ligament, as well as the ability to participate in early rehabilitation. Patients who were obtunded or unable to adhere to the protocols for other reasons were excluded. Early rehabilitation consisted of initiating a standardized physical therapy protocol on postoperative day 1 involving removal of the extension splint for quadriceps activation and ROM exercises. Late rehabilitation consisted of full-time immobilization in an extension splint for 3 weeks. Following this 3-week period, both groups engaged in the same standardized physical therapy protocol. All surgical reconstructions were performed at a single center by one of two fellowship-trained sports orthopaedic surgeons, and all involved allograft Achilles tendon PCL reconstruction. When possible, hamstring autograft was used for ACL and medial collateral ligament reconstructions, whereas lateral collateral ligament and posterolateral reconstruction was performed primarily with allograft. The primary outcome was the number of patients undergoing manipulation during the first 6 months. Additional outcomes added after trial registration were patient-reported quality of life scores (ML-QOL) at 1 year and an objective assessment of laxity through a physical examination and stress radiographs at 1 year. One patient from each group was not assessed for laxity or ROM at 1 year, and one patient from each group did not complete the ML-QOL questionnaires. No patient crossover was observed. With the numbers available, there was no difference in the use of knee manipulation during the first 6 months between the rehabilitation groups: 1 of 18 patients in the early group and 4 of 18 patients in the late group (p = 0.34). Similarly, there were no differences in knee ROM, stability, or patient-reported quality of life (ML-QOL) between the groups at 1 year. With the numbers available in this study, we were unable to demonstrate a difference between early and late knee rehabilitation with regard to knee stiffness, laxity, or patient-reported quality of life outcomes. The results of this small, randomized pilot study suggest a potential role for early rehabilitation after multiligament reconstruction for knee dislocation, which should be further explored in larger multi-institutional studies. Level II, therapeutic study.