EXPLORING APPROPRIATE EXERCISES FOR REHABILITATION IN A POST-STROKE PATIENT WITH IHD AND HYPOTHYROIDISM

According to a systemic analysis conducted in 2017, the blunt stroke incidence in various parts of India ranged from 44.29 to 559 per 100,000 people over the previous two decades. Stroke is the sudden loss of any neurological function due to a disturbance of blood flow. The majority of stroke victims suffer from long-term disability. We present the case of a 72-year-old woman who was admitted to the hospital with symptoms of fatigue on the left side of her body and facial palsy on the left side, on further assessment it was found that patient had coronary artery bypass grafting before 10 years with no post-operative complications and also had a history of hypothyroidism, this brings about the suspicion about the correlation between the stroke with the history of IHD and hypothyroidism. To manage these passive movements breathing exercises, bed mobility exercises, strengthening exercises followed by gait training was given which was highly effective to make the patient independent and return to her daily activities

REHABILITATION OF STROKE IN CYANOTIC CONGENITAL SINGLE VENTRICLE HEART DEFECT PATIENT

Congenital heart disease consists of various conditions including tetralogy of Fallot, ventricular septal defect, Epstein’s anomaly, single ventricle, etc. Among these single ventricles is one of the gravest forms of cyanotic congenital heart disease. The cardiac diagnosis is associated with an increased risk of stroke among children. Pediatric arterial ischemic stroke (AIS) is an important cause of neurologic disease in children causing disability. The 14-year-old patient came to the hospital was presented with left side hemiplegia with severe exercise intolerance due to congenital heart disease. The patient has been advised to undergo Fontan procedure for single-ventricle condition 3 years back, but due to poor socioeconomic status, parents of patients refused to do so. The primary goal was to improve bed mobility and trunk balance without developing symptoms of exercise intolerance. The intervention was started with deep and segmental breathing exercises. Proprioceptive neuromuscular facilitation and constrained induced movement therapy were added in the program in addition to passive and active movements, bed mobility, functional reeducation, trunk control exercises, and balance exercises. Combinations of all of the above therapeutic approaches lead to increased functional independence in the patient. This case reports the effectiveness of a rehabilitation program for pediatric arterial ischemic stroke with preventive guidelines for exercise intolerance.

Bedform segregation and locking increase storage of natural and synthetic particles in rivers

While the ecological significance of hyporheic exchange and fine particle transport in rivers is well established, these processes are generally considered irrelevant to riverbed morphodynamics. We show that coupling between hyporheic exchange, suspended sediment deposition, and sand bedform motion strongly modulates morphodynamics and sorts bed sediments. Hyporheic exchange focuses fine-particle deposition within and below mobile bedforms, which suppresses bed mobility. However, deposited fines are also remobilized by bedform motion, providing a mechanism for segregating coarse and fine particles in the bed. Surprisingly, two distinct end states emerge from the competing interplay of bed stabilization and remobilization: a locked state in which fine particle deposition completely stabilizes the bed, and a dynamic equilibrium in which frequent remobilization sorts the bed and restores mobility. These findings demonstrate the significance of hyporheic exchange to riverbed morphodynamics and clarify how dynamic interactions between coarse and fine particles produce sedimentary patterns commonly found in rivers.

IMPACT OF LOCOMOTOR TRAINING IN IMPROVING FUNCTION AFTER STROKE

Stroke is among the world's leading causes of death, disability and functional inability for adults. The incidence of stroke currently exceeds that of Western developed nations in India. Increased understanding of the risk factors for stroke is hoped to lessen the future prevalence. Recurrence rates of stroke are high. The incidence and ability of individuals to recover varies widely. Stroke affects health by affecting the functioning system resulting in disabilities, physical problems, and a lower quality of life. Physiotherapy is instrumental to restore lost sensations and motor skills and to deal with patient's emotional needs. This case report describes a case of A 66 year old male retired PWD worker, who was referred to physiotherapy with complaints of weakness in left upper and lower extremities and inability to perform movements of left side. He had a sudden loss of power in the left side one day prior and was diagnosed with stroke along straightening of the dorso-lumbar spine and disc bulges at C2-C6, L4-S1 levels on X-ray and MRI scan. Physiotherapy rehabilitation was started with bed mobility and transfer activities with further progress to sitting and standing activity. As the transfers improved, we progressed to balance training, lower limb strengthening, and gait training in which task specific training was focused. Later, we concluded that balance and locomotor training has a great impact on functional recovery post-stroke.

Effects of Proprioceptive Neuromuscular Facilitation (PNF) Techniques on Bed Mobility, Transfer and Early Trunk Control in Acute Stroke Patients

Aims: The aim of this study was to observe the effects of Proprioceptive neuromuscular facilitation (PNF) Techniques to improve bed mobility, transfer and early trunk control in Stroke patients. Study Design: Assessor blinded Randomized Control Trail. Place and Duration of the Study: Physiotherapy department of Shalamar hospital Lahore, Pakistan from March 2019 to September 2020. Methodology: A total of 50 acute stroke patients with severity level NIHSS>21 were recruited and randomly allocated into 2 groups (males: 29, females: 21; age range: 50 to 65) after obtaining written informed consent. Patients were assessed at baseline 0 week and after 6 week of post treatment on Trunk impairment scale (TIS) and ICU mobility scale. Results: It showed that PNF base trunk control exercises exhibited significant improvement in Trunk impairment scale(TIS) in Group A as compared with Group B at post-test, 18.44±3.176 vs 16.12±2.35 (p=0.004) respectively. ICU Mobility scale significantly improves at post-test in Group A as compared to Group B, 7.52 ±2.583 vs 5.84±1.434 (p=0.007) respectively. Conclusion: This study concluded that PNF based trunk exercise showed more improvement in Group A (Trunk stability exercises using PNF techniques) when compared with conventional training.

Bedform segregation and locking increase storage of natural and synthetic particles in rivers

While the ecological significance of hyporheic exchange and fine particle transport in rivers is well established, these processes are generally considered irrelevant to riverbed morphodynamics. We show that coupling between hyporheic exchange, suspended sediment deposition, and sand bedform motion strongly modulates morphodynamics and sorts bed sediments. Hyporheic exchange focuses fine-particle deposition within and below mobile bedforms, which suppresses bed mobility. However, deposited fines are also remobilized by bedform motion, providing a mechanism for segregating coarse and fine particles in the bed. Surprisingly, two distinct end states emerge from the competing interplay of bed stabilization and remobilization: a locked state in which fine particle deposition completely stabilizes the bed, and a dynamic equilibrium in which frequent remobilization sorts the bed and restores mobility. These findings demonstrate the significance of hyporheic exchange to riverbed morphodynamics and clarify how dynamic interactions between coarse and fine particles produce sedimentary patterns commonly found in rivers

THE EFFECT OF TASK ORIENTED FUNCTIONAL TRAINING PROGRAMME IN ELDERLY WITH HEMORRHAGIC STROKE- A CASE STUDY

BACKGROUND- A 70 year old unknown male patient was found unconscious on road and was brought to tertiary care hospital. On investigations and clinical correlation, patient was diagnosed as a case of left hemiparesis secondary to acute middle cerebral artery infarct. Patient regained consciousness on next day and was in state of complete dependence for bed mobility and daily living activities. He was managed conservatively and was referred to occupational therapy department for further management. METHOD- Patient was evaluated by using uniform terminology. Modied Barthel index, Modied Rankin Scale, Basic MOCA scale and Stroke Specic QOL scales were administered. Patient was given intervention for 5 weeks. Enabling activities with self-care functional activities were practised. Accident prevention, activity promotion, Compensatory strategies and environmental modications were done. Scales were administered post intervention and comparative data was obtained. RESULT- Change of pre-intervention and post- intervention score indicates improvements in performing activities of daily living, reduced disability, improved cognition and quality of living. There were signicant improvement in activities like eating, drinking milk, in bed mobility dressing and coming to sit. Minimum to moderate improvement was seen in activities like toileting, walking, stair climbing and use of wheelchair. Despite his age and lack of family support, signicant functional improvements were documented in this elderly stroke patient, and he was discharged to old age home. CONCLUSION- Supplementing enabling activities with task oriented functional training is feasible and effective in improving independence for activity of daily living in elderly stroke

Morphodynamic styles: characterising the behaviour of gravel-bed rivers using a novel, quantitative index

The assessment of channels widely focusses on using channel form to identify channel character, but fail to capture the more nuanced variations of morphodynamics without the analysis of process. This paper presents a method using an index of channel behaviour, the throughput ratio (ζ), which is calculated from morphologic change and sediment transport, and explores the viability of inferring process from channel form to act as an indicator of channel behaviour. Two experiments using the same initial width, slope, discharge and grain size were used to demonstrate the effectiveness of this method in representing different morphodynamics. In one experiment the channel was allowed to laterally deform, whilst the other had unerodible elements placed at its boundaries. As a result the experiment with mobile banks widened and reduced sediment transport to zero, whereas the fixed bank experiment— unable to decrease its shear stress— continued to output material. In both, the rate of morphologic change tended to zero despite their marked differences in sediment transport over time. The differences in evolution are due to the differences in process available to each channel despite a starting similarity in bed mobility and their gross similarity in a meandering planform. The throughput ratio allows new representations of the temporal and spatial patterns of the morphodynamics, providing additional measures with which to analyse the processes acting in river channels.

Dynamic modeling of mineral bed mobility in centrifugal concentrators

The article discusses a method for determining the effective parameters of centrifugal concentrators with fluidization of a mineral bed with water through holes in the walls of a rotating cone. The device and the principle of operation of a laboratory setup for studying the constrained movement of mineral particles in a centrifugal field are described. Also, the optimization of the degree of loosening of the mineral bed in the centrifugal concentrator is considered. It was established experimentally that with existing water flow rates the condition of the mineral bed was close to the pressed state. Using the developed method of optimizing the ratio of water pressure in the fluidization system and the separation factor, the optimum water pressure and its flow rate were calculated in laboratory conditions. As a result, it was possible to raise the extraction during the first stage of gravity concentration by 2%. Therefore, it was determined that the degree of loosening depends on the correlation of the separation factor and the water pressure in the fluidization system. Based on the proposed approach, it is possible to develop an automation system to adjust the parameters of the centrifugal concentrators. Based on the results of calculating the balance of the concentration process in the gold extraction plant at the Kedrovskoe deposit, it was established that the application of the proposed methodology helped to improve the efficiency of the centrifugal free-flow concentrator.