Standard Physical Therapy Program Research Articles

Effect of Adding Shoulder Stabilization Exercises to the Rehabilitation of Postoperative Hand Injuries in Young Adult Patients.

Hand injuries are common and could have an impact on all upper limb functions. Engaging shoulder muscle training during the rehabilitation protocol postoperatively could have a significant impact on regaining all upper limb function. The purpose of this study was to assess the effect of adding shoulder stabilization exercise to hand rehabilitation postoperatively. Forty patients were randomly assigned to 2 equal groups. Group A received a standard physical therapy program plus shoulder exercise protocol and group B received only a standard physical therapy protocol for hand rehabilitation. Outcome measures were pain intensity; grip strength; Arabic modified Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; and range of motion (ROM). All outcome measures were assessed before and after treatment. Statistical analysis revealed that both groups, the experimental and control, showed significant improvement in all outcome measures, but experimental group A showed significant improvement than the control group B posttreatment for hand grip strength, ROM, and QuickDASH questioners (P < .001). Adding shoulder stabilizer muscle training to the hand rehabilitation protocol postoperatively has a significant impact on hand function outcomes.

Effects of Compression Intervention on the Thigh Using Elastic Bandage on Lateral Femoral Pain After Trochanteric Fractures: A Multicenter Randomized Controlled Trial.

A trochanteric fracture is one type of hip fracture. Management of postoperative pain after trochanteric fracture that is caused by decreased gliding between tissues in the lateral thigh is not established. The aim of this study was to examine the effect of compression of the thigh using an elastic bandage on trochanteric fracture after surgery. Multicenter randomized controlled trial was conducted in collaboration with the Comprehensive Rehabilitation Unit (sub-acute rehabilitation Unit) in two hospitals. Eligible volunteers (n = 34) with trochanteric fractures after surgery were randomly assigned to two groups. In the treatment group, participants practiced standing and walking under compression of the thigh with an elastic bandage. The control group was blinded to the intervention and practiced standing and walking under non-compression of the thigh with an elastic bandage. Both groups underwent a standard physical therapy program 2 times a day, daily. Two-way repeated measures of ANOVA showed significant main effect between the groups for gliding between tissue (p < .001), lateral femoral pain (p < .001), subcutaneous tissue thickness (p = .044). Compression of the thigh with an elastic bandage significantly improved subcutaneous tissue thickness, gliding between tissues, lateral thigh pain. Gait velocity improved with these functional improvements.

The effect of mirror therapy on joint movement, pain and functionality in acute upper limb burns

ObjectiveMirror therapy is aimed at developing a normal proprioceptive perception for the area with pain or movement restriction by making use of the person's monitoring of the healthy side movements thanks to the mirror's reflective feature. The aim of this study is to investigate the effect of mirror therapy on joint range of motion, pain and functionality in acute upper extremity burn injuries. MethodsDemographic and burn-specific data of individuals with upper extremity burns were recorded. Individuals were divided into two groups. Standard treatment was applied to the first group, and mirror treatment in addition to the standard treatment was applied to the second group for 30 sessions, 5 days a week for 6 weeks. In the standard treatment program, passive, active-assisted and active ROM, strengthening, stretching, resistant and functional exercises were applied. In the mirror therapy group, active exercises were performed on the healthy side by covering the burn area in the mirror box. Before and after the treatment, joint range of motion(ROM) was evaluated with Universal Goniometer, pain intensity was evaluated with Visual Analog Scale and upper extremity functions were evaluated with QuickDASH. ResultsA total of 32 (23 Male, 9 Female) individuals between the ages of 18–65 were included. The mean total burn surface area was 12.93 ± 9.80 in the standard treatment and 6.12 ± 2.96 in the mirror treatment. The groups were similar in terms of ROM change (p > 0.05). The pretest/posttest pain scores of both the standard therapy and mirror therapy groups were similar (p > 0.05). There was no statistically significant difference in terms of pretest and posttest QuickDASH scores according to the groups (p > 0.05). The difference between the pretest/posttest QuickDASH scores of both Standard treatment and Mirror treatment groups was statistically significant. ConclusionThis study showed that the standard physiotherapy and rehabilitation program applied in the acute period in upper extremity burns and the mirror treatment applied in addition to this program provide similar improvements in joint range of motion and pain.

Effect of adding trunk core training exercise to conventional therapy on patients with chronic mechanical neck pain

Background: One of the most frequent causes of musculoskeletal pain in the general population is cervicalgia, sometimes known as neck pain. Its estimated prevalence ranges from 16.7% to 71.5 percent, and it should be noted that up to 50% of these cases may develop into chronic conditions. In this study, patients with persistent mechanical neck pain were examined to determine the effectiveness of trunk core training exercises on pain, range of motion, functional impairment, and muscle activity. Purpose: The goal of the study was to determine the impact of adding core training to patients' existing conventional treatments for chronic mechanical neck pain. Methods: Twenty male and twenty female patients with persistent mechanical neck pain, ranging in age from 18 to 40, participated in this study. The cases were classified into two equal groups randomly (A and B). Group A has got standard physiotherapy program (Passive stretching of the upper fibers of trapezius, sternocleidomastoid, and scalene muscles, Isometric strengthening exercises of neck muscles, hot pack). Group B has obtained standard physiotherapy program in addition to trunk core training program. 

Effectiveness of high intensity laser therapy on pain, grip strength and median nerve conductivity in pregnant women with carpal tunnel syndrome: A randomized controlled trial

Study designSingle-blind randomized controlled trial. IntroductionHigh-intensity laser therapy (HILT) was recently introduced to the physiotherapy field as a treatment option for patients with carpal tunnel syndrome (CTS). However, evidence about its effectiveness on pregnant women with CTS is sparse. Purpose of studyTo test the effectiveness of HILT combined with a conventional physical therapy program to reduce pain intensity, sensory and motor nerve distal latency, and increase grip strength in pregnant women with CTS compared with the physical therapy alone. MethodsFifty-four pregnant women with mild to moderate CTS were randomized and further allocated into two groups. The HILT group (n = 27) received both HILT and conventional physical therapy, and the control group (n = 27) received only physical therapy, including nerve and tendon gliding exercises and the use of an orthotic device. Participants received the interventions at the University Hospital (omitted for review) three times per week for 5 weeks. An 11-points numerical pain rating scale, electromyography, and a handheld dynamometer were used for data collection before and after the treatment. ResultsParticipants from both groups presented significant improvement in the median nerve motor nerve distal latency (MNDL), sensory nerve distal latency, numerical pain rating scale, and handgrip strength after the intervention. The between-group difference showed more improvements in participants of the HILT group on reducing pain intensity, mean difference (MD) = -3.11 (-4.1 to 2.1), and sensory nerve distal latency, MD = -0.3 (-0.5 to -0.1) compared with the control group. DiscussionHILT produced greater improvement in outcomes of pregnant women with mild to moderate CTS whichsuggests that adding HILT to traditional CTS physical therapy protocol is beneficial and safe. ConclusionsHigh-intensity laser therapy combined with a standard physical therapy program for CTS in pregnant women is better than the physical therapy program alone to improve pain intensity and median nerve sensory distal latency.

Does Blood Flow Restriction Therapy Improve Leg Strength in Patients With a Painful Total Knee Arthroplasty?

Blood flow restriction (BFR) therapy has been proposed to help patients build strength with fewer repetitions than standard physical therapy (PT). We sought to determine if BFR would improve quadriceps and hamstring strength in patients with instability and perceived weakness >1 year after primary total knee arthroplasty (TKA). We retrospectively reviewed 48 patients with painful TKAs and flexion instability as well as quadriceps and hamstring weakness who performed a 6-week PT program and received isokinetic strength measurements (ISMs). Thirty-six patients completed a standard PT program (non-BFR) and 12 patients completed a BFR regimen. ISMs were taken before and after PT to quantify quadriceps and hamstring power, torque, and work compared to the contralateral leg. Statistical analysis was conducted on pre-PT and post-PT ISMs and decisions for revision surgery. There were no differences in ISMs after PT between the BFR and non-BFR groups. The non-BFR group showed statistically significant strength improvements in flexion but not extension (+28.7%-32.8%, P= .0145-.255). Although no significant difference was found in the BFR group, they saw improvements in all extension strength metrics (19.4%-23.4%, P= .3315-.3901) and flexion (25.7%-29.9%, P= .1994-.2392). No difference was observed between the groups in the rates of subsequent revision TKA (8.3% vs 16.7%, P= .3362). BFR did not improve quadriceps and hamstring strength compared to PT alone in patients with instability and weakness after TKA. Over 80% of total patients chose to avoid revision TKA after completion of focused PT with or without BFR.

Efficacy of Virtual Reality-Based Rehabilitation Interventions to Improve Balance Function in Patients with Cerebral Palsy: A Systematic Review and Meta-analysis of RCTs

Context: Cerebral palsy (CP) results from damage to the central nervous system, leading to disturbances of motor and sensory functions, especially the balance. Virtual reality exercise intervention (VRI) is a promising technique to improve motor function in children with CP by engaging such individuals in real-like world events through simulations. This review study examines the effects of VRI on static and functional balances and summarizes the effective protocols of virtual reality-based rehabilitation interventions for the CP patients. Methods: A comprehensive search was performed using the following databases: Medline/PubMed, Scopus, Cochrane Library, PEDro, EBSCOhost, and the Online Library of the University of London. The PEDro scale was used to assess the methodological quality. The data extracted from the reviewed studies were coded according to Cooper and Hedges’ guidelines considering the following criteria: (I) Patients' characteristics, (II) intervention protocols, (III) outcomes, and (IV) results. To this end, twelve RCTs with 248 patients aged 4 - 20 years old were analyzed and assessed as "fair" to "good" methodological quality according to Pedro’s scale (4 to 8). VRI alone or in combination with a standard physiotherapy program or with other tools such as tDCS was applied. Results: Twelve RCTs met the inclusion criteria. The meta-analysis showed the good effect of VRI on the static and functional balances of patients with CP (Cohen’s d = 0.66). The funnel plot revealed no significant asymmetry or heterogeneity among the studies (P = 0.271, I2 = 19.71%), reflecting the absence of publication biases. Conclusions: This review reports four major perspectives of the VRI applications: (1) VRI settings, (2) selection of exercises, (3) outcome measures, and (4) long-term effects. Moreover, this review summarizes the specific effects of VRI on balance improvement in patients with CP from different perspectives. However, considering the limited number of well-conducted RCTs in this field, a large homogeneous samples size is still needed for future RCTs.

Comparative assessment of osteopathy technique with manual therapy associated with biofeedback in patients with the lumbar spine pain

Introduction: The aim of the study is to assess the impact of physiotherapy containing elements of osteopathy on the change of pain level of the lumbar spine of patients in comparison to traditional management using orthopedic manual therapy combined with biofeedback. Material and methods: The study included 60 people qualified for outpatient rehabilitation. Patients were divided into two groups (research and control) consisting of 30 people. The mean age of patients was 52.75 ± 11.58 years. Patients were examined before and after the implementation of the rehabilitation process, pain scale (VAS) and Oswestry Disability Index were used for the study. Rehabilitation lasted every day for four weeks. The control group used orthopedic manual therapy combined with biofeedback, while the research group used a series of treatments based on osteopathy techniques. In addition, both groups of patients underwent a standard physical therapy program. Results: The study showed the effectiveness of manual therapy combined with biofeedback and osteopathic therapy in patients with lumbar spine pain syndrome. A decrease in pain was noted in patients of both groups, however a greater decrease was noted in the research group. In the assessment using the Oswestry Disability Index, a comparable level of quality of life was noted in both treatment groups. Conclusions: The introduced therapeutic programs show an improvement both in terms of reducing pain and improving functioning in everyday life, however, the rehabilitation process based on osteopathic techniques is more effective in reducing pain.

Comparison of the Supervised and Home-Based Physiotherapy Program in Patients with Lateral Epicondylitis

Objective: This study aimed to compare the effectiveness of a supervised and home-based physiotherapy program in the reduction of pain and in improving functional status and quality of life in patients with lateral epicondylitis. Method: Patients diagnosed with lateral epicondylitis and referred to the physiotherapy clinic were evaluated retrospectively. A total of 32 patients were separated into two groups as supervised and home-based physiotherapy groups. All the patients received standard physiotherapy program consisting of static stretching exercises of the ECRB tendon, eccentric exercises of the wrist extensors and cold application, for 3 weeks. The groups were compared in terms of pain severity, range of motion, functional status (Quick-DASH) and quality of life (SF-36) after treatment. Results: Fifteen patients (12 females, 3 males) with a mean age of 44.20±7.35 years were included in the supervised physiotherapy group, and 17 patients (15 females, 2 males) with a mean age of 48.65±12.33 years in the home-based physiotherapy group. There was no statistically significant difference in activity (p=0.980) and rest pain (p=0.483), wrist flexion (p=0.775) and extension (p=0.838) range of motion, functionality (p=0.346) and quality of life (p=0.923) between groups. Conclusion: Patients participating in a home-based physiotherapy program had similar clinical outcomes in terms of pain intensity, range of motion, functionality, and quality of life as patients participating in a supervised physiotherapy. Further prospective randomized studies can be conducted by increasing the sample size and comparing with cost analyzes to determine the rehabilitation regimen that will provide the best outcomes in lateral epicondylitis rehabilitation.

Effects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial

ObjectivesTo investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge. DesignA single-blinded, parallel groups, randomized controlled trial. SettingsOutpatient rehabilitation center. ParticipantsThirty-four patients (N=34), aged 31.3±7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups. InterventionsThe Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks. Main Outcome MeasuresThe primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention. ResultsAfter 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05). ConclusionsPatients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.

Effects of adding neural mobilization to traditional physical therapy on pain, functional disability, and H-reflex in patients after lumbar laminectomy: A randomized controlled trial

Objective: To investigate whether adding neural mobilization to a standard postoperative physical therapy program could improve the outcomes of patients after lumbar laminectomy. Design: A single blinded randomized controlled trial. Setting: Outpatient setting. Participants: Sixty participants of both sexes who had undergone lumbar laminectomy. Interventions: Participants were allocated randomly to two groups; study and control groups. All patients received a standard postoperative physical therapy program. Those in the study group received additional neural mobilization in the form of straight leg raising and dorsiflexion with two-ended slider. Treatment was administered three times/week for six successive weeks. Outcome measures: Visual analog scale (VAS), Oswestry disability index (ODI), and H-reflex latency were measured pre and post-treatment. Results: The mean age of participants was 44.23 ± 4.64 and 45.3 ± 5.3 in study and control groups respectively (P > 0.05). There were statistically significant differences in VAS, ODI, and H-reflex latency in favor of the study group (P < 0.05). The mean ± SD for VAS, ODI, and H-reflex latency pre vs post treatment was 6.13 ± 1.22 vs 1.40 ± 0.77, 64.46 ± 4.05 vs 16.86 ± 2.55, and 32.07 ± 2.76 vs 27.46 ±1.79 in study group and 5.86 ± 1.07 vs 2.46 ± 0.73, 63.93 ± 3.91 vs 23.40 ± 2.93, and 31.76 ± 2.69 vs 29.4 ± 1.94 in control group, respectively. Conclusions: Neural mobilization combined with traditional physical therapy program achieved better improvement in pain, functional disability and H-reflex in patients who underwent decompressive laminectomy than traditional physical therapy program only.

Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis.

There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. Method: This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. Results: While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. Conclusion: The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.

A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial

To investigate the possible effects of multisite injection therapy around the shoulder and prospectively compare the pain relief, range of motion (ROM), and functional scores of randomly selected patients with primary frozen shoulder using the American Shoulder and Elbow Surgeons score and the University of California-Los Angeles score after the completion of a standard physiotherapy program. Seventy-six patients with primary frozen shoulder were randomly divided into 2 groups based on the treatment: multisite injection and single injection. In the multisite-injection group, the glenohumeral joint and posteroinferior capsule, subacromial space, posterosuperior capsule, biceps long head, and coracohumeral ligament were injected with a combination of 2 mL of triamcinolone acetonide (40 mg/mL), 4 mL of bupivacaine (0.5%), and 34 mL of saline solution. The glenohumeral joint in the single-injection group was injected with 1 mL of triamcinolone acetonide (40 mg/mL) and 2 mL of bupivacaine (0.5%). Patients in both groups underwent physical therapy using the same protocol. Patients were evaluated for pain (visual analog scale score), functional status, and active and passive joint ROM at 1, 3, and 6 months and 1 year after the injection. The follow-up rate was 82.6%, and significantly lower VAS scores were recorded in all periods in the multisite-injection group compared with the single-injection group (P= .01). In terms of active and passive ROM, the follow-up results were significantly better in the multisite-injection group (P < .05). Significantly higher functional scores were recorded in the multisite-injection group (P < .05). Both treatments were effective in patients with primary frozen shoulder. However, the multisite-injection technique provided better pain palliation, better ROM restoration, and better functional results than the single glenohumeral injection in patients with primary frozen shoulder who were treated with the same physiotherapy regimen. Level I, prognostic comparative study.

Case Report

Background and Purpose: This case report describes the hydrotherapy sessions received in conjunction with a rehabilitation program designed for a patient recovering from coronavirus disease 2019 (COVID-19) with intensive care unit (ICU)–acquired muscle weakness. The primary purpose of this case report was to examine the effects of hydrotherapy in a patient recovered from COVID-19 with ICU-acquired muscle weakness in the absence of any cross-infection. Case Description: The subject was a 29-year-old man in recovery after contracting COVID-19 infection and ICU-acquired muscle weakness. On admission to the orthopedic rehabilitation ward at Sheba Medical Center, the patient tested negative for COVID-19 according to the polymerase chain reaction test. Intervention: The patient received 4 hydrotherapy sessions that involved exercising in warm water (31°C-35°C) to improve muscle strength in a non- or low–weight-bearing capacity. A standard physical therapy program was also provided to the patient. Outcome: Following 2 weeks of rehabilitation that included 4 hydrotherapy sessions combined with a standard physiotherapy regimen, the patient was discharged home and able to walk outdoors independently for at least 30 minutes. Aside from the inclusion of specific personal protective equipment and social distancing (2 m), no additional requirements were necessary to our standard pool hygiene and no adverse infections were reported. Discussion: The results of this case report showed that hydrotherapy is a useful modality in the rehabilitation of ICU-acquired muscle weakness developed as a result of COVID-19.

Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial.

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

Efficacy of Sensory Rehabilitation on Pain and Hand Function in Patients with Median Nerve Entrapment

A common Carpal tunnel syndrome (CTS) is aneuropathic entrapment for the upper limbs with middle-aged people being at higher risk. To study how sensory rehabilitation impacts pain and functional outcome of hand in carpal tunnel syndrome patients. Twenty females with CTS, aged 25-45 years were enrolled. They were allocated at random to two groups; Group I: provided for sensory rehabilitation in addition to a standard physical therapy program and Group II: received only the standard physical therapy program only.  Pre and post-treatment assessment included Visual Analogue Scale (VAS) and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). In both post-treatment groups, the decrease of mean VAS and BCTQ scores was statistically significant. No substantial difference between the two groups in the measured parameters pre or post treatment. Adding sensory rehabilitation has nearly the same efficacy as the standard physical therapy program alone in decreasing pain, enhancing hand function in mild and moderate patients with CTS.

Efficacy of ankle kinesiotape on balance in children with spastic diplegia

BackgroundAdequate and efficient standing postural balance is key for functional walking and handling abilities in children with spastic diplegia. This study was designed to evaluate the effect of kinesiotape applied on ankle dorsiflexor muscles on balance in children with spastic diplegia. Thirty children with spastic diplegia of both genders participated in the study: 16 boys and 14 girls between 4 and 10 years old. They were divided randomly and equally into two groups: a control group, in which children received the standard physical therapy program for children with diplegia; and the study group, who received the same physical therapy program as in the control group but after kinesiotape application over the ankle dorsiflexor muscles. Both groups received the treatment program for 1 h, three times per week, for three successive months. Postural stability was assessed through evaluation of three stability index (anteroposterior, mediolateral, and overall) for all children by the Biodex Balance System before and after treatment.ResultsStatistical analysis of results before and after treatment was performed by mixed MANOVA to compare effects both within and between groups on stability indexes, and post hoc tests were carried out for subsequent multiple comparison. The level of significance for all statistical tests was set at p < 0.05. Before treatment, there was no significant difference in the stability index between both groups (p > 0.05). Comparison between both groups post-treatment revealed a significant decrease in the measured variables of the study group compared with that of the control group (p < 0.05).ConclusionAdding ankle kinesiotaping over dorsiflexor muscles in conjunction with a balance and gait training exercise program for children with diplegia can enhance postural stability and decrease sway. This study suggests that it should be added to the treatment program for children with diplegia.Trial registrationThis study was registered retroactively. Identifier: NCT04243928

Mouth Mask versus Pursed Lip Breathing on Ventilatory Functions and Dyspnea Index in Chronic Obstructive Pulmonary Disease

Abstract Background: Chronic Obstructive Pulmonary Disease (COPD) is a rising health problem. Dyspnea causes reduction of functional status and quality of life in it. Pursed Lips Breathing (PLB) and mouth mask use to reduce dyspnea and improve quality of life. Aim of Study: To compare the effect of mouth mask versus pursed lip breathing on ventilatory functions and dyspnea index in patient with chronic obstructive lung disease. Subjects and Methods: Forty men patient presented with chronic obstructive pulmonary disease (FEV1/FVC <0.70) were selected from outpatient clinic at Chest Department Kasr El-Ainy Hospital, age ranged from 50-65 years old. Ventilatory functions, Dyspnea index, oxygen saturation, CATscore ques-tionnaire, were measured pre and post training program. Patients were assigned in two groups. Group (A): Consisted of 20 patients were treated by expiratory breathing through Mouth Mask plus standard chest physiotherapy. Group (B) consisted of 20 patients were treated by pursed lip breathing plus standard chest physiotherapy Program was for five days per week for 8 weeks. Results: There was a significant increase in FVC, FEV1 and FEV1/FVC post-treatment compared with that pre-treatment with a percent of improvement 19.25%, 44.29%, 21.5% respectively in the group A and 8.7%, 18.37%, 8.9% respectively in group B (p < 0.001). There was a significant decrease in CAT post-treatment compared with that pre-treatment with apercent of improvement 61.07% and 46.07% respectively in the group A and B (p < 0.001). There was a significant increase in FEV1 with the mean difference between both groups was 0.28L and a significant decrease in CAT of the group A compared with that of the group B the mean difference between both groups was –5.1 (p < 0.05). There was a significant decrease in DI pre and post 3min step test post-treatment in the group A and B compared with that pre-treatment (p < 0.0001). Pre-treatment the median value of DI (pre 3min step test) of the group A was 2 and group B was 2 and that post-treatment was 0 for group A and 1 for group B. Pre-treatment the median value of DI (post 3min step test) of the group A was 3 and group B was 3 and post-treatment for group A was 1 and group B was 1.5. and comparison between the A and B post-treatment revealed a significant decrease in DI pre and post 3min step test of the group A compared with that of the group B. Conclusion: Mouth mask and pursed lip breathing are effective in improving ventilatory functions, improving of dyspnea, improving of health status and physical activity in patient with chronic obstructive lung disease. As there is improvement in CAT score questionnaire ventilatory param-eters and Dyspnea index in COPD.

Efficacy of Sensory Re-Education Paradigm on Functional Outcomes in Patients with Carpal Tunnel Syndrome

Abstract Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Aim of Study: The aim of the study was to investigate the efficacy of sensory re-education paradigm on functional outcomes of patients with carpal tunnel syndrome. Subjects and Methods: Thirty participants was be randomly assigned to either the sensory re-education paradigm group or the traditional physical therapy group. First group (control group), the patients received standard physical therapy program including progressive active and resisted therapeutic exercises, median nerve gliding exercises and tendon gliding exercises. Second group (experimental study group), the patients received sensory re-education paradigm as the followings; Step 1: Splinting as a constant maintained touch for fifteen minutes, Step 2: Topical anesthesia for pain reduction by using 8% Lidocaine spray for 15 minutes, Step 3: Massage using different textures; graduating from the softest to rougher one with same speed and pressure, Step 4: Proprioceptive Neuromuscular Facilitation (PNF) technique using extension, adduction and internal rotation with extended elbow pattern. Sensory function was assessed by Semmes-Weinstein monofilament, pain intensity level was assessed by a Visual Analogue Scale (VAS), hand grip was assessed by using hand held dynamom-eter and functional outcomes were assessed by using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: There was a statistically significant improvement in the measured parameters in both groups when comparing their pre and post-treatment mean values. However, significant difference was recorded between the two groups after treatment in favor of the study group. Conclusion: The obtained results suggest that the appli-cation of sensory re-education paradigm become a beneficial therapeutic technique in improving the functional outcomes as a whole in patients with CTS when adjunct to a physical therapy program.

Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial.

Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running. In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200Hz was extracted and analyzed within six-time intervals of 30ms. Statistical nonparametric mapping was performed to identify power spectra differences. Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30ms before to 30ms after initial contact showed significantly lower intensities than the intervals from 30 to 150ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups. Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.