Dalfampridine for Mobility Limitations in People With Multiple Sclerosis May Be Augmented by Physical Therapy: A Non-randomized Two-Group Proof-of-Concept Pilot Study

Purpose: To demonstrate proof-of-concept for a combined physical therapy and pharmacological intervention and obtain preliminary estimates of the therapeutic efficacy of a motor-relearning physical therapy intervention with and without concurrent dalfampridine treatment on gait speed in people with mobility limitations due to multiple sclerosis (MS).Methods: Using a non-randomized, two-group design, 4 individuals with MS newly prescribed dalfampridine as part of their routine medical care, and 4 individuals with MS not taking dalfampridine completed a 3-week drug run-in or no-treatment baseline, respectively. After 3 weeks, all participants commenced physical therapy twice weekly for 6 weeks. Participants taking dalfampridine took the medication for the study duration. The physical therapy program comprised functional strengthening, gait training, balance training, and dual-task training. The primary outcome was Timed 25-foot Walk (T25FW) at the end of the 6-week physical therapy program.Results: For the 4 participants taking dalfampridine, average improvement in T25FW on drug only was 12.8% (95% CI 1.2 to 24.4%). During the 6-week physical therapy phase, both groups significantly improved T25FW, but the effect tended to favor the group taking dalfampridine (mean difference = −0.93 s, 95% CI −1.9 to 0.07 s, p = 0.064, d = 1.6). Whereas the physical therapy group had average T25FW improvement of 10.8% (95% CI 1.0 to 20.5%), the physical therapy plus dalfampridine group demonstrated average improvement of 20.7% (95% CI 3.8 to 37.6%).Conclusions: Further research is warranted to examine whether dalfampridine for mobility impairment may be augmented by physical therapy in people with MS.

Effect of cough assist device on blood gasses and period of mechanical ventilator for pneumonic children with general hypotonia

Background Cough assist devices play an important role with patients in the intensive care unit (ICU), particularly those with neuromuscular diseases which had abnormal muscle tone. It was previously thought to be the main technique for improving cough efficacy, which aids in weaning from mechanical ventilation and improves patient outcomes. So, we selected randomly the odd numbers from Abo El-Reesh hospital records, and 30 children of both sexes with pneumonia were selected, aged from 6 months to 3 years, who were selected from intensive care unit: fifteen children were the control group, who received the selected physical therapy program (postural drainage, percussion and resist diaphragm), and another fifteen children were the study group, who received previous physical therapy program, which was selected, and cough assist device. Results This study revealed the effect of cough assist device on blood gasses and the period of mechanical ventilator on children with pneumonia and general hypotonia. There was a significant decrease in pH, PaCO2, and HCO3 post treatment compared with that pretreatment in the study and control groups (p < 0.05). The percentage of decrease in pH, PaCO2, and HCO3 in study group A were 0.4, 38.26, and 30.28% respectively while that in the control group were 0.4, 32.56, and 25.48% for pH, PaCO2, and HCO3 respectively. There was a significant increase in PaO2 post treatment compared with that pretreatment in the study and control groups (p < 0.001). The percentage of increase in PaO2 in the study group was 32.13% and that in control group was 30.09%. There was no significant difference in pH, PaCO2, and HCO3 between both groups pre-treatment (p ˃ 0.05). Also, there was no significant difference between groups post treatment (p ˃ 0.05). The median (IQR) period of mechanical ventilation in the study group was 5 (7, 4) days while that in control group was 8 (18, 5) days. There was a significant decrease in period of mechanical ventilator of the study group compared with that of control group (p = 0.03). Conclusion The cough assist device and physical therapy program were selected for children in the intensive care unit which have the same effect on arterial blood gasses as they optimize pH, PO2, PCO2, and HCO3, but the cough assist device helps in accelerating weaning of mechanical ventilator so as decrease the period of mechanical ventilator.

Incorporating patient preferences into osteoarthritis treatment

Objectives: This study aims to identify the relationship between treatment modalities and the patients’ preferences in osteoarthritis (OA) treatment and identify the related factors. Patients and methods: This multi-center, cross-sectional study included a total of 305 patients with OA (66 males, 239 females; mean age: 66.4±9.7 years; range, 38 to 90 years) between July 2019 and January 2020. Data including demographic and clinical characteristics of the patients were recorded using a structured questionnaire. Results: The mostly common involvement sites were knee joints, lumbar, and cervical regions, respectively. Prior to the study, the treatment modalities which were prescribed to patients were oral drugs (79.7%), topical drugs (73.8%), home-based exercise program (62.6%), and physical therapy (outpatient) (61.3%). Of the recommended remedy, 89.2% were prescribed by physiatrists, 24.6% by orthopedists, 5.6% by family practitioners, 2.6% by neurosurgeons, and 1.6% by algologists. The most beneficial treatments (to whom) were inpatient physical therapy program (47%), oral drugs (41%), home-based exercise programs (24.9%) according to patients’ perspective. According to patient preferences, nearly half of the patients preferred outpatient physical therapy program (45.9%), oral drugs (33.1%), inpatient physical therapy (20%), and home-based exercises (18%). The most common reasons for their preferences were previous benefits from treatment (54.4%), long-term effects (38%), easy access to treatment (33.1%) and concerns about side effects (28.9%). The mostly common reasons for their preferences were previous benefits from the treatment (54.4%), long-term positive effects of physical therapy (38%), easy access to the treatment (33.1%) and concerns about side effects of drugs (28.9%). Conclusion: Besides medical regimen, the results of this study showed that the patients preferred outpatient and inpatient physical therapy modalities, and home-based exercises programs. In the light of these findings, initiation of a new prescription (e.g., drugs or physical therapy modalities) in OA patients, previous treatment modalities, and approaches are suggested to be carefully reviewed by the clinician to anticipate and improve the adherence behavior to the new treatment.

Study on the incidence of spine deviations in hearing deficiency students

The correct posture of students is conditioned by a multitude of factors. The spine is the axis around which the other body segments are positioned for a harmonious body. The purpose of this study is to identify the incidence of spinal deviations at students with sensory hearing impairments selected in the physical therapy program conducted in special schools in Bucharest. We wanted to find out if there are statistical differences between the two categories of subjects (with mild/moderate deficiencies and with poor/severe/deep and/or associated deficiencies) related to the incidence of deformities/deviations in the spine. The research sample was composed of 216 students enrolled in special education in Bucharest. The criteria for forming the working groups were: hearing impairment, degree of disability, gender and level of education (primary or secondary). Conclusions. The incidence of the disease is different in students with hearing impairments enrolled in primary and secondary education. For students with poor/severe/profound hearing impairment, the most common condition is lordosis followed by kypholordosis and neurological disorders.

Correction of Motor Disability Impairments by Physical Therapy Means in Women after Cesarean Section

In modern obstetrics, the frequency of abdominal accouchement is constantly increasing. Therefore, the problem of restoring the state of health of women after surgical delivery requires the introduction of new medical knowledge and technologies into practical rehabilitation, in particular, methods of physical therapy. The purpose of the study was to determine the influence of the developed program of physical therapy on the dynamics of the parameters of the motor ability of women in the postpartum period after cesarean section. Materials and methods. 112 women were examined after childbirth. The comparison group consisted of 47 women who had a natural childbirth. The main group 1 consisted of 32 women who did not want to carry out the proposed program of physical therapy; they were provided with general recommendations for self-observation in the postpartum period after cesarean section. The main group 2 consisted of 33 women after cesarean section who underwent postpartum physical therapy for 12 months (kinesitherapy (therapeutic exercises, functional training to improve motor skills and abilities), abdominal wall bandage, kinesiotaping, abdominal and general massage, wellness nutrition, psychological relaxation, education of women). Determination of motor ability according to the Functional Movement Screen was performed in the late postpartum period (6-8 weeks), 6 and 12 months after childbirth. Results and discussion. In women in the late postpartum period, regardless of the type of delivery, signs of impaired motor ability are revealed, which was established by the results of the Functional Movement Screen test exercises. Within a year after childbirth, there is a gradual improvement in the motor ability of women, regardless of the type of delivery and their performance of active restorative interventions. The use of a physical therapy program starting from the early postpartum period in women after cesarean section revealed advantages regarding the state of their motor ability in relation to women who underwent natural delivery and those who recovered from cesarean section on their own, according to separate Functional Movement Screen tests already at the end of the late postpartum period. After 1 year after childbirth, women who underwent cesarean section and performed the developed physiotherapy intervention on all Functional Movement Screen tests demonstrated a statistically significantly better result compared to women who underwent natural delivery and those who recovered from cesarean section on their own. Women who underwent cesarean section, but recovered on their own with the help of general recommendations, according to the signs of impaired movement capacity 1 year after childbirth could not reach the levels of women who gave birth by vaginal delivery and women who underwent a physical therapy program. Conclusion. It is advisable to prescribe physical therapy means from the first day of postpartum rehabilitation in order to level the signs of impaired motor capacity for quick postpartum recovery of women and their return to full functioning

Correction of carbohydrate metabolism by means of physical therapy of patients with metabolic syndrome

Purpose: to investigate the characteristics of carbohydrate metabolism indicators in patients with metabolic syndrome before the beginning of rehabilitation effects as well as to trace the dynamics of indicators in the process of application of our physical therapy comprehensive program. Material and methods. The survey involved 70 women with metabolic syndrome, who were divided into the main (MG) (35 women) and control (CG) (35 women) groups with the average age in the MG 31.49±0.71-year-olds, in the CG – 31,06±0,57 -year-old. In the main group, a physical therapy program was applied for patients with metabolic syndrome, which includes a hypo caloric diet with a hypolipidemic focus; therapeutic massage according to the method of P.B. Efimenko for patients alimentary-constitutional obesity; medical gymnastics using elements of sports-oriented aerobics and special physical exercises based on Pilates gymnastics using fitballs and expanders; morning hygienic gymnastics; limited walking in combination with breathing exercises, taking into account the activity of the autonomic nervous system. Result. As a result of a comprehensive and developed physical therapy program that was justified and applied for 4 months for patients with metabolic syndrome, the studied carbohydrate metabolism parameters changed significantly. Main group women showed significantly improved indicators of glycemia on empty stomach: from 8,85±1,54 to 5,98±0,81mmol / l, glycemia after eating: from 11,47±1,85 to 7,68±0,86mmol / l and reached the target levels of diabetes compensation and diagnostic criteria for the metabolic syndrome. Conclusions: physical exercises contribute to the improvement and normalization of carbohydrate metabolism. They restore adaptation to physical exertion and normalize the function of the cardiovascular system, motor activity and psychoemotional state as well.

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.