Acute giardiasis and Chapman reflexes: Musculoskeletal symptoms preceding, during and after infection

Giardiasis is an acute infection caused by Giardia lamblia, which produces profuse secretory diarrhea that can lead to dehydration and electrolyte derangement. Musculoskeletal manifestations resulting because of giardiasis occur due to prolonged inflammation and viscero-somatic reflexes of the pathophysiology for this disease process. By treating the parasitic infection with an antiparasitic agent, as well as treating the somatic dysfunctions with osteopathic manipulative treatment, analgesics and a home exercise program, the patient in the following article experienced an uneventful course of treatment and a complete recovery including resolution of the pain.

The Effect of a Home Exercise Program on Visio-Vestibular Function in Concussed Pediatric Patients

ObjectiveTo explore if a home exercise program (HEP) affects visio-vestibular function in concussed pediatric patients.BackgroundA HEP can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. It is unclear if pediatric patients prescribed a HEP demonstrate improved visio-vestibular function.Design/MethodsThis observational study included 1,041 patients (59% female; age = 14.0 ± 2.5 years) reporting to a specialty care concussion center for an initial visit ≤28 days post-injury and follow-up ≤60 days post-injury. All patients completed a Visio-Vestibular Examination (VVE) at both timepoints consisting of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Patients were prescribed a HEP (1–2 times/day) at initial visit consisting of exercises addressing visio-vestibular deficits. At follow-up, patients reported their progress: (1) has not done the HEP, (2) is currently doing the HEP, or (3) has completed the HEP. Primary outcomes included HEP progress, VVE subtests (normal/abnormal), and total VVE (abnormal = 2 + abnormal subtests). Chi-square tests with Bonferroni corrections were used to determine if abnormal VVE outcomes were associated with HEP status.ResultsAt initial visit, 81 2(77.6%) patients presented with abnormal total VVE. At follow-up, the proportion of abnormal total VVE did not differ among patients not doing the HEP (101 [62.0%]), patients currently doing the HEP (516 [69.0%]), and patients who had completed the HEP (51 [69.0%]). However among VVE subtests, a lower proportion who completed the HEP presented with abnormal smooth pursuit (7.5%), horizontal (3.8%) and vertical (3.8%) saccades, and complex tandem gait (0%) relative to patients currently doing the HEP (p = 0.003) and patients not doing the HEP (p = 0.01).ConclusionsOur findings indicate that patients who completed the HEP presented with improved elements of visio-vestibular function relative to those who did not start or were currently doing the HEP.

Comparison of exercise-based cancer rehabilitation delivered in-person or via telehealth (TeleCaRe): a randomised controlled trial protocol (Preprint)

BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Exercise-based rehabilitation may be delivered remotely but it is unknown how it compares to in-person cancer rehabilitation. OBJECTIVE To evaluate the effectiveness of an exercise-based cancer rehabilitation program delivered via telehealth compared to a traditional in-person model for improving quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic, non-inferiority randomised controlled trial with embedded cost-effectiveness and qualitative analysis will be completed. One-hundred and twenty-four cancer survivors will be recruited from a metropolitan health network in Melbourne, Australia. The experimental group will attend an 8-week, twice weekly, 60-minute, exercise group supervised via videoconferencing supplemented by an online home exercise program and information portal. The comparison group will attend an 8-week, twice weekly, 60-minute, supervised exercise group in person, supplemented by a written home exercise program and information booklets. Assessments will be completed at week 0 (baseline), week 9 (post-intervention) and week 26 (follow-up). The primary outcome will be health related quality of life measured by the EORTC QLQ-C30 at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire) and recording of adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semi-structured interviews will be completed and analysed using a framework approach to determine the impact of delivery mode on patient experience. The primary outcome will be analysed using linear mixed effects models. RESULTS Trial not yet recruiting. Anticipated commencement January 2022. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about safety, effectiveness, cost and patient experience. CLINICALTRIAL The TeleCaRe Trial has been approved by the Eastern Health Human Research Ethics Committee (E21-012-74698) and is funded by the Victorian Cancer Agency. This trial is prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12621001417875. Registered 21st October, 2021.

Efficacy of Instrument Assisted Soft-Tissue Mobilization in Patients with Heel Pain: An Experimental Study

Aim: The purpose of this study was to evaluate and compare the effects of Instrument-Assisted Soft-Tissue Mobilisation (IASTM) and Therapeutic Ultrasound in patients with heel pain in terms of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. This was undertaken as even though Ultrasound is regularly used, heel pain still remains resistant to treatment in some patients. Hence, the need to compare a relatively newer technique with it. Study Design : Experimental study Place and Duration: Department of Musculoskeletal Physiotherapy Sciences, Ravi Nair Physiotherapy College, Sawangi (Meghe) , Wardha , duration of 12 months. Methods: Seventy people (n=70) with heel discomfort (lasting 6 weeks to 1 year) were chosen at random and placed into two groups, each getting eight therapy sessions. IASTM and Home Exercise Program was given to Group A, whereas Therapeutic Ultrasound and Home Exercise Program was given to Group Calf muscle stretches and Plantar fascia stretches were incorporated in the Home Exercise Programme. Outcome measures were recorded both at the beginning of treatment and after final treatment. The patients were assessed for Numerical Pain Rating Scale with first step in morning and at the beginning of first session and after end of last session and for Foot and Ankle Ability Measure scale at the beginning of first session and after end of last session. A follow up period of 90 days (after last session) was taken, the measurements of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale were taken again to see the long-term effects. Results: Group A which received IASTM + Home exercises showed great improvements than Ultrasound and Home exercise group, from baseline to week 4 after the pain intensity and foot function were assessed using Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. Statistically significant differences were found in both the groups. i.e. P=0.0001. But 7 people in Ultrasound group complained of pain and functional ability at follow-up session. Conclusion: In this study, it can be concluded that combining both the IASTM and Home Exercise Program have got beneficial effects in decreasing the pain intensity thus improving the foot and ankle function in patients with heel pain.

Adherence to a home physical exercise program in patients with osteoporotic vertebral fractures: A retrospective observational study

BACKGROUND: Adherence to treatment is one of the most common problems in patients suffering from chronic disease such as osteoporosis, and special commitment is required to patients, especially regarding rehabilitation. There is increasing evidence that physical interventions aimed at relieving pain and reducing physical impairments could play a crucial role in improving the quality of life and reducing the risk of fractures in patients with severe osteoporosis. OBJECTIVE: The aim of this study was to assess the compliance and determine the acceptability of a home-self-managed exercises program in patients with vertebral fractures, one of the most frequent and serious consequences of osteoporosis. METHODS: We conducted a retrospective observational study of patients undergoing a home exercise program, monitoring them with clinical scales, questionnaires, and routine visits. RESULTS: 62.86% of the patients were compliant with the treatment; the absence of supervision by health personnel was the primary cause of non-compliance, followed by the lack of time and the lack of motivation. Compliant patients showed a significant reduction in lumbar pain (p 0.011), an improvement in posture with a reduction of dorsal kyphosis (occipital-wall distance T0-T1, p-value = 0.02) and an improvement in QoL (p-value = 0.001) and physical performance at the 20 m walking test (p-value = 0.003). CONCLUSIONS: A home exercise program is feasible and could improve signs and symptoms in patients with vertebral fractures due to OP.

Effect of Cervical Mobilization and Transcutaneous Supraorbital Nerve Stimulation in Migraine Without Aura

Migraine is one of the most common disabling headache disorders which is categorized into two broad types based on the number of headache days. It is called episodic or general migraine if the attacks occur less than 15 days per month, and it is categorized as chronic or transformed migraine if headache occur on 15 or more days per month. This study was conducted to find out the effect of strategy for pain using a modality and strategy using mobilization in reducing disability, frequency and pain in migraine without aura. Thirty-Two subjects were selected based on diagnostic criteria for migraine and divided into two groups. Group A received Cervical Mobilization and Myofascial Release with home exercise program and Group B received Transcutaneous Supraorbital Nerve Stimulation with home exercise program. Visual Analogue Scale, Questionnaire (HIT-6) were recorded as outcome on baseline and after 3 weeks. Results showed significant improvements in both the groups with, p<0.01. Between group comparisons elicited non-significant differences with p˃ 0.05. Following the results, it can be concluded that cervical mobilization and Transcutaneous Supraorbital nerve stimulation can be added as a valuable adjunct to medical management in the treatment of migraine without aura.