Scapular Malalignment in Patients with Stroke: A Narrative Review

Background: Scapular Malalignment leads to functional incapacity in stroke patients. This malalignment hampers the functional mobility and stability of shoulder joint in stroke patients due to which there is reduced range of motion and hampers activities of daily living in stroke patients. So, to investigate the extent of scapular malalignment in patients with acute, chronic and sub-acute stroke. Methods: Four databases (PubMed, Google Scholar, Cochrane, Science Direct) were searched to identify eligible studies using the keywords Scapular Malalignment and Stroke. Only observational studies published in last 10 years (2010-2020) were included in this review. Results: Eight Studies, included in the review were conducted on patients with acute, sub-acute and chronic stage. The results showed that there is more of inferior angle tilting seen in patients with stroke and it increases with spasticity and alters functional mobility in patients with stroke. Discussion: All studies were consistent in using the appropriate tools for measurement of scapular malalignment. Literature showed scapular malalignment affects scapular balance angle, functional mobility of hand and range of motion in patients with acute, sub-acute and chronic stroke. Most of the literature includes patients with sub-acute and chronic stroke. There was no conflict of evidence observed among all articles. Conclusion: There is influence of Scapular malalignment on spasticity, duration of stroke, upper limb mobility, and range of motion in stroke patients. Scapular Malalignment is observed in acute, sub-acute and chronic rotation and there is more of inferior angle tilting and rotation of scapula observed. KEY WORDS: Scapular Malalignment, stroke.

To Assess and Correlate Cardiorespiratory Adaptations in Endurance-Trained Cyclist and Recreational Cyclist

Background: This cross-sectional study aimed to compare and correlate HRV indices, body composition, and aerobic power (VO2max) in recreational cyclists and trained endurance (road) cyclists. 47 male cyclists participated in the study (age: 20.32 ± 0.365; height: 171.50 ± 1.117; BMI: 23.00 ± 0.47) divided into 3 groups (Group 1: Recreational cyclist; group 2: Delhi Cyclist, playing at State/National level; and group 3: IGI cyclist, playing at National/International level). Methods: The participants underwent body composition analysis (BMI, Subcutaneous whole body, body density, body fat %, lean body mass) and anthropometry profiling. HRV was recorded (RMSSD, pNN50%, SDNN, LH/HF ratio) at resting state (~5 minutes) using the Heartware Shimmer ECG device. Later 3 minutes McArdle step test was done to measure VO2 max. Result: The VO2max (F2, 44=22.821, P<0.001) and Body fat % (7-Fold) (F2, 44=6.772, P=0.003) differed significantly between the 3 groups of cyclists. A highly significant negative correlation was seen between cycling experience in years with Resting HR and LF/HF ratio (p<0.01) with their r- values at -.382 and -.448 respectively, and statistically significant negative correlation was indicated with Body fat% (7-fold), r=-.322 (p<0.05). Conclusion: Significant differences were seen in the aerobic capacity (VO2max) between all the 3 groups of cyclists. Improved VO2max in trained road cyclists can be particularly due to the nature of cycling (endurance) training, overall training volume, and reduction in the body fat % and fat mass, which further enhances the adaptations to autonomic control. KEY WORDS: adaptation, autonomic nervous system, body composition, cardiorespiratory, cyclist, endurance, HRV, recreational, road cycling, VO2max.

Inter and Intra Rater Reliability of Different Measurement Techniques of Weight Bearing Ankle Dorsiflexion Range of Motion

Background: Measurement of range of motion is a crucial parameter in the physiotherapeutic evaluation and follow up. Ankle dorsiflexion is important for functional activities like running, jogging, waking, stair climbing. Restricted ankle dorsiflexion is seen in various lower limb injuries. Therefore, assessment of dorsiflexion is important to assess function. Goniometer, tape measure, mobile goniometer, inclinometer is used to measure ankle dorsiflexion range of motion in weight bearing and non-weight bearing positions. Weight bearing dorsiflexion has reported higher intra and inter-rater reliability as compared to non-weight bearing ankle dorsiflexion. All these measures may be taken by the same and by different therapists in the management of one patient. Therefore, it is necessary to determine if the measurements used are reliable both within and between the therapists. Material and Methods: 50 healthy subjects were recruited and their role was explained in the study. Written consent was taken from all the subjects. Weight bearing lunge was done in which the subject was asked to stand with the heel in contact with the ground and the great toe 10 cm away from the wall and the knee touching the wall. Inclinometer, standard goniometer, mobile goniometer and tape measure were administered to check for ankle dorsifexion range of motion. Results: ICC for inter rater reliability was almost perfect for tape measure and goniometer (0.968 and 0.837 respectively) and it was substantial for inclinometer and mobile goniometer (0.746 and 0.796 respectively). ICC for intra rater reliability was almost perfect for tape measure, inclinometer and goniometer (0.965,0.894 and 0.837 respectively) and it was substantial for mobile goniometer (0.802). Conclusion: The inter-rater reliability of tape measure, goniometer is almost perfect and for mobile goniometer, inclinometer is substantial. The intra rater reliability of tape measure, inclinometer, goniometer is almost perfect and mobile goniometer is substantial. KEY WORDS: Dorsiflexion, Mobile goniometer, Tape measure, Goniometer, Inclinometer, Reliability.

COVID and Post COVID Physical Therapy of a 63-year-old male with affection of Balance: A Case Report

Background: The global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) has a harsh effect throughout the world. A wide range of neuromuscular symptoms including myalgia, anosmia, loss of taste and muscle weakness have been seen post COVID-19 infection. Some of these symptoms may impair balance and activities of daily living. Balance is defined as ability of an individual to maintain the line of gravity within the base of support. Objective: This case report study shows how physiotherapy management was helpful for a 63-year-old male during COVID and post-COVID rehabilitation to enhance his functional recovery. It also describes balance training strategies which were used in addition to regular pulmonary physiotherapy in a patient affected with COVID-19. Case Study: This study reports a four-month long physiotherapy protocol of a 63-year-old male patient admitted to a hospital due to COVID-19 in whom imbalance was also observed. Physiotherapy management was started for the same. The protocol included in-patient as well as out-patient exercises. Pulmonary physiotherapy along with neuro physiotherapy, in the form of balance training, were included. The patient showed good improvement in balance and regained his functional independence and hence discharged from physiotherapy treatment. Conclusion: Thus, Covid and post- COVID-19 physiotherapy rehabilitation is essential to elicit positive adaptive changes to improve the functional capacity, independence in the daily activities and QOL. KEY WORDS COVID-19, Static Balance, Dynamic Balance, Fatigue, Neuromuscular Disorders.

Physiotherapy in Long Term Physical and Mental Health of People Recovered from COVID 19: A Systematic Review Protocol

The objective of the study to design a protocol on the effectiveness of physiotherapy on long term physical and mental health of recovered patients from coronavirus disease 2019. Methods: The following electronic databases will be searched from inception to December 2021: PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Databases, and other databases. We will include all published documents regarding this topic. Two separate individuals will analyse studies and select accordingly after removal of duplicate studies. Then, final screening, assessment of quality of the articles and data analysis will be done. Meta-analyses, subgroup analysis, and descriptive analysis will be performed based on the included data conditions. Results: Methodological heterogeneity analysis of current evidence will be provided from Physical health outcomes like Barthel Index or Functional Independence measure scale and questionnaires describing health status like Physical Health Questionnaire and Mental health outcomes like SRQ-20, Hamilton Depression scale or Hamilton Anxiety scale. Conclusion: This study will provide the evidence regarding the importance of physiotherapy in future physical and mental health of recovered COVID-19 patients, when performed during treatment of disease in acute hospital management. PROSPERO registration number: CRD42020190863 KEY WORDS: Coronavirus disease 2019, Protocol, Rehabilitation, Review.

Augmented Core Breathing Pelvic Floor Muscle Training for Patients with Genitourinary Syndrome in Different Phases of Menopause

Pelvic floor muscle has a role in core breathing for twenty-four hours and offers an influence to modulate the lumbar spine and pelvic floor. Several studies reported on pelvic floor muscle strength. Women with genitourinary syndrome do not seek care for their condition and are dismayed to speak with the health care provider about the condition. In the present work, we evaluated the efficiency of augmented core breathing in the genitourinary syndrome of menopause for pelvic floor muscle strength. We tested the role of augmented core breathing efficacy using pelvic floor muscle training in patients with the genitourinary syndrome. Our data revealed significant beneficial effects of core breathing with pelvic floor muscle training and Kegel’s exercise in patients with genitourinary syndrome in different phase of menopause. KEY WORDS: genitourinary syndrome; menopause; pelvic exerciser; pelvic floor muscle training; Utian quality of life scale.

Co-relation of functional mobility with anxiety in traumatic below knee amputees

Background: Amputation is defined as the surgical removal of one or more parts of the body. It causes great stress to the physical and mental wellbeing of an individual. The incidence of lower limb amputation is greater as compared to upper limb amputation. Also lower limb amputees experience more restricted mobility than upper limb amputee patients. Rehabilitation is an important to the recovery of an amputee. In cases of planned amputation, rehabilitation starts before the surgery. It involves physiotherapy, occupational therapy and recreational training. There is little to no studies on the co-relation of anxiety with functional mobility in amputees. This study focusses on the same. Context and purpose: Amputation causes restricted mobility and decreased quality of life. A study on the relation between anxiety and mobility will indicate a different outlook of a holistic approach while treating mobility issues in below knee amputees. Materials and methods: This is a one group co-relational study design. Study was conducted after taking approval from the institutional ethics committee and all the subjects gave their written informed consent. The study was conducted at Yashwantrao Chavan Memorial Hospital, Pune. Result: Statistical analysis of the data was done using the Pearson’s co-relation co-efficient and a co-relation was found between anxiety and functional mobility in below knee amputee patients. Conclusion: There is a co-relation between functional mobility and anxiety. Patients with anxiety showed a reduced performance on the functional mobility scale than the patients without anxiety. KEY WORDS: Amputation, Anxiety, below knee amputation, functional mobility, rehabilitation.

Effect of Matrix Rhythm Therapy in Venous Ulcer Healing: A case report

Introduction: Venous Ulcers are due to abnormal vein function. People may inherit a tendency for abnormal vein. Common causes of damaged veins include blood clots, injury, ageing and obesity. This is one of the common problems for professionals who are standing by nature. Symptoms include swelling, aching and tiredness in the legs. Usually a red, irritated skin rash develops into a open wound. Matrix Rhythm Therapy (MaRhyThe) is a recent clinical modality, which works on cell biology and gives good results in pain management and restriction of movements. intervention: Matrix Rhythm Therapy was applied on posterior aspect of leg region extending around the wound are once a week for 8 weeks with treatment duration of 60 minutes. Result: Pain of the subject after 8 session was 0 at rest and 2 while walking on the basis of VAS. Wound size is length 8 cm and breadth 7 cm and 2 mm dept and categorized as Type A grade 1 which completely healed with healthy scar. The photographic evidence is suggestive considerable healing of venous ulcers are noted between each session of matrix rhythm therapy (MaRhyThe). Conclusion: Study concludes that Matrix rhythm therapy (MaRhyThe) could be considered as adjunct in wound healing of venous ulcers. KEY WORDS: Matrix rhythm Therapy, Venous ulcers.

The effectiveness of dry needling on hamstring flexibility: A systematic review

Background: Hamstring injuries are a common problem for athletes, and hamstring tightness has been found to be a contributing factor to these injuries. Dry needling is a growing trend that poses the possibility of increasing flexibility through several mechanisms; however, there is currently no review on all of the studies done concerning the effectiveness of dry needling for improving hamstring flexibility. Purpose: The purpose of this systematic review was to evaluate the effectiveness of dry needling on hamstring flexibility in people with hamstring tightness. Methods: Search terms included dry needling or intramuscular stimulation, flexibility or range of motion or ROM, and hamstring. The databases searched were PubMed, MEDLINE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL.) Results: Ten articles were found from the initial search, and three remained after the removal of duplicates and screening the articles for abstracts and full text. Patients consisted of relatively young individuals with hamstring tightness. All studies used a stretching group for the comparison while interventions consisted of dry needling alone or dry needling with a stretching program. No studies showed a significant difference between dry needling and the control; however, all studies found that flexibility increased from baseline measurements following a dry needling treatment. Discussion: The results indicate that while dry needling may not be a better option than stretching, it could be used as a means for improving hamstring flexibility. Possible factors for the effectiveness of dry needling include increased blood flow and oxygen saturation to the muscle as well as the release of myofascial trigger points. Conclusion: Dry needling was not found to be significantly better than stretching, but poses a possibility as another method for improving hamstring flexibility. KEY WORDS: Hamstrings, Athletes, Flexibility, Tightness, Dry Needling, Stretching.

Relationship between modified TUG and WeeFIM in children with cerebral palsy

Background: Cerebral Palsy (CP) refers to permanent, mutable motor development disorders stemming from a primary brain lesion, leading to secondary musculoskeletal alterations, and limitation of activities of daily living. Motor impairment is the main manifestation in children with CP, and it has consequent effects on the biomechanics of the body. The WeeFIM is a short and quick to administer assessment of functional outcome in paediatric rehabilitation. The modified Timed Up and Go test (mTUG) was designed for children with Cerebral Palsy and assesses mobility and requires both static and dynamic balance. Context and Purpose: Determining if a relationship exists between functional mobility and level of functional independence in daily activities will help to design treatment programs which target improvement in functional mobility in order to improve functional independence in children with Cerebral Palsy. The studies done correlating functional balance and functional performance in children with CP have largely yielded inconclusive results. Hence this study was designed with the aim of finding if a relationship exists between functional mobility measured by mTUG and functional independence measured by WeeFIM in children with CP. Methods: It was a correlation study conducted on 20 children with spastic cerebral palsy from different CP centers in and around Mangalore. Participants were evaluated using modified TUG and WeeFIM scales and the scores tabulated and subjected to statistical analysis to determine if there is a relationship exists between mTUG and WeeFIM. Results: When the measured variables were correlated with each other using Pearson’s correlation it was found that the Pearson’s correlation coefficient was - .470, indicating a moderate negative correlation between the mTUG and WeeFIMscores. Conclusion: There exists a positive relationship between functional mobility and functional independence in children with CP. Improving mobility in children with CP can help them to attain better functional independence. KEY WORD: Cerebral Palsy, GMFC, mTUG, WeeFIM.