Case Report on Secondary Complications of Neck Dissection Surgery

The most common malignant neoplasm which affects structures of oral cavity is squamous cell carcinoma (SCC). Common sites of oral SCC are tongue and floor of mouth followed by buccal mucosa, gingiva and soft palate. Predisposing factors such as smoking, tobacco chewing along with alcohol consumption leads to carcinoma. SCC of gingiva located in keratinized portion is normally painless. Yoon et al described the clinical aspect of oral SCC which can vary from white plaque to an infected ulcerative lesion1. Gingiva squamous cell carcinoma shows features like exophytic mass with granular, papillary or present as ulcer. Patient comes to the doctor with predominant symptom like gum pain. Premolar and molar lesion are common sites and lower jaw is likely affected more than upper jaw.2Gingiva SCC is mostly asymptomatic in nature during early phase and frequently misdiagnosed as inflammatory lesion of oral cavity such as periodontitis, pyogenic granulomas, and inflammatory hyperplasia. Misinterpreted or delayed diagnosis and treatment leads to slow prognosis.3The gold standard treatment for Head and Neck cancer is surgery combined with radiotherapy or chemotherapy. Surgery often leads to dissection of lymph nodes because lymph nodes are the main source of further spread of metastasis. Patient who had undergone to neck dissection surgery for head and neck cancer should start early physical therapy rehabilitation program. Along with home program therapist assisted physical therapy sessions leads to early betterment of patient and early prognosis.4 Physical therapy plays important role in post-operative period. It reduces post-surgical immobility period in order to reduce further post-surgical complication as well as minimize chances of developing malfunction of shoulder joint. Follow up for long period is necessary. Early intervention of physical therapy is helpful for reducing pain, maintaining arm mobility.4Immediately after surgery of head and neck cancer, reduced range of head and neck as well as reduced and painful range of shoulder becomes more prominent. Post-operative functional impairment affect the quality of life so early rehabilitation including speech therapy, physiotherapy should be intensified as early as possible.5The most common malignant neoplasm which affects structures of oral cavity is squamous cell carcinoma. The gold standard treatment for Head and Neck cancer is surgery combined with radiotherapy or chemotherapy. Surgery often leads to dissection of lymph nodes because lymph nodes are the main source of further spread of metastasis. Patient who had undergone to neck dissection surgery for head and neck cancer should start early physical therapy rehabilitation program. Along with home program therapist assisted physical therapy sessions leads to early betterment of patient and early prognosis. Post-operative functional impairment affect the quality of life so early rehabilitation including speech therapy, physiotherapy should be intensified as early as possible. Post operatively patient tend to take rest without doing any mobility exercises due to pain which further leads to the restriction and complication of the joint.

Impact of Pressure Ulcers on Therapeutic Outcomes in Inpatient Physiotherapy Services.

Pressure ulcers have been associated with an extended length of hospitalization, sepsis and mortality. Over the last few decades, little has been written about the impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. It is obvious that critically ill patients, who are sedated, ventilated, patients with chronic neurological, musculoskeletal and cardio-respiratory disorders who are bed ridden for prolonged period of time are particularly at risk of developing skin breakdown. This will help in identifying barriers to patient participation and develop strategies to pressure ulcer prevention. We wanted to determine the impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. MethodsThe study was conducted from June 2015 to January 2016. The impact of pressure ulcer on inpatient physiotherapy services was determined by detailed physical assessment, evaluation with Functional Independence Measure score (FIM) and Braden Q Scale. A total 96 subjects were assessed during this time. ResultsThere was statistically significant impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. The FIM takes into consideration self-care, sphincter control, transfers, locomotion, communication social cognition. A poor score denotes poor outcome at discharge. Tissue level assessment was carried out by using Braden Q Scale, a poor score of which again denotes very poor outcome in mobility, activity, sensory perception, moisture, friction – shear, nutrition, tissue perfusion and oxygenation. ConclusionsPressure ulcer is one of the preventable problems; but in majority of cases it becomes the main reason for poor therapeutic outcome.

Effect of Advanced Strengthening Program on Physical Fitness Test Performance in Injury Prone Pre-Military Trainee Cadets.

The pre military trainee cadets are mostly unaware about proper training techniques and because of their lack of knowledge they are prone to have musculoskeletal problems especially their shoulder, spine, and knee joint are more prone to any injury. So, in order to avoid injuries, effort was made to make them aware about the risk of getting injured and proper fitness techniques which will prevent their injuries as well as help them to improve fitness level and field performance also. We wanted to evaluate the effect of advance strengthening program on physical fitness test performance in pre-military trainee cadets.METHODSIn this comparative study, injury prone trainee cadets were randomly allocated in to two groups of 25 each with advanced training program. Group one did conventional type of routine exercise; group two followed advanced training protocol. Physical fitness test performance was assessed and compared between the two groups. Outcome measures were Burpees test, shoulder press, chin-ups, planks, leg press, 1600 meters running.RESULTSIn Burpees test, 37% improvement was seen by conventional exercise program; whereas, it was 63% for advanced strengthening exercise program. In shoulder press, 38% improvement was seen for conventional exercise program; whereas, it was 62% for advanced strengthening exercise program. In chin ups, 34% improvement was seen for conventional exercise program; whereas, it was 66% for advanced strengthening exercise program. In planks, 45% improvement was seen with conventional exercise program; whereas, it was 55% for advanced strengthening exercise program. In leg press, 39% improvement was seen with conventional exercise program; whereas, it was 61% with advanced strengthening exercise program. In 1600 meters running, 37% improvement was seen with conventional exercise program; whereas, it was 63% by advanced strengthening exercise program. P value was <0.0001 which is significant.CONCLUSIONSA significant improvement was found in muscle performance, and occurrence of injury was seen to be reduced with advanced training program in injury prone trainee cadets.

The Model of a Physiotherapy Syllabus Based on Choice Based Credit System (CBCS).

Current professional and higher educational curriculum reforms demand the implementation of Choice-Based Credit System (CBCS). In India, the University Grants Commission (UGC) has notified about use CBCS. Some health sciences universities have started its implementation but not much attempts were made in designing a BPTh syllabus as per CBCS framework. We wanted to propose a model BPTh syllabus to fit into choice-based credit system.METHODSA desk review of all information related curriculum was conducted by using a data abstraction sheet. A model BPTh syllabus prototype for CBCS was designed based on the national and international guidelines, recommendations of statutory and governing national and international organisations.RESULTSSemester based BPTh syllabus was designed without changing the norms of four- and half-year degree course. All the must-to-know areas of the theory, practical, tutorial, project/dissertation, were considered as “core” areas and the desirable and nice to know areas are left for “electives” by the students. Physiotherapy specific teaching, learning, and evaluative methods are included in the curriculum.CONCLUSIONSThe existing BPTh syllabus can be effectively modified based on the national and international guidelines, recommendations of statutory and governing national and international organisations, for choice-based credit system. The proposed model focuses required changes that are needed for adoption of CBCS without neglecting or reducing the weightage of any core subject.

Effect of Multicomponent Exercise Program on Selected Gait and Balance Parameters in Young Obese Females.

Obesity is a major global health problem. It is now commonly seen in young population due to their lifestyle and unhealthy eating habits. Obesity is now more common in younger females. Due to hormonal changes, body may not adapt, which may lead to life threatening and irreversible conditions. Obesity affects many physical factors including gait and balance. We wanted to study the correlation between obesity and gait-balance parameters, the effect of multi component exercise program on selected gait and balance parameters in young obese females. We also wanted to study its effect on dynamic balance, and compare it with conventional exercise program.METHODSIn this comparative study two groups were created with 20 participants with obesity grade 1 BMI in each. Group 2 underwent 26 weeks of multi component exercise. Group 1 underwent conventional exercises. Data was assessed and analysed. Outcome measures were body mass index, base of support, stride length, step length, cadence, and functional reach test.RESULTSBody mass index for group 1 after their conventional exercise decreased in 47% while in group 2 with multi component exercise protocol BMI reduced in 53% population. Similarly base of support for group 1 was 42% and group 2 was 58%; stride length in group 1 was 42% and group 2 was 58%; step length for group 1 was 42% and group 2 was 58%; cadence for group 1 was 42% and group 2 was 58%; functional reach test was 42% and 58% for group 1 and group 2 respectively.CONCLUSIONSA significant improvement was found in selected gait and balance parameters in young obese women with the help of multi component exercise program.

Effect of Occupational Load Specific Exercise Protocol on Cumulative Trauma Disorder of Upper Limb in Construction Workers.

Construction workers suffer major musculoskeletal problems in day to day life like back pain, altered posture, etc. One such major problem is due to overuse of upper limb. Till now studies were published on low back pain in construction workers. But, studies related to cumulative trauma disorder of upper limb are new. As majorly upper limb is used by construction workers for their work, so it is necessary to study the effect of occupational load specific exercise protocol on cumulative trauma disorder of upper limb. We wanted to study the effect of occupational load specific exercise protocol on cumulative trauma disorder of upper limb.METHODSIn this comparative study, 42 construction workers, randomly allocated into two groups with 21 in each group with cumulative trauma disorder of upper limb were included. VAS , range of motion and manual muscle testing were the major outcome measures to assess pain intensity in construction workers with cumulative trauma disorder of upper limb. Later, data was collected, and analysis was done.RESULTSIn group A, pain intensity was 68% before conventional exercise program whereas it was reduced to 23% after conventional exercise program. In group B, pain intensity was 69% before occupational load specific exercise program whereas it was reduced to 8% after occupational load specific exercise program. For shoulder joint, in group A, ROM was 45% before conventional exercise program whereas it was improved to 55% after conventional exercise program. In group B, ROM was 41% before occupational load specific exercise program; whereas, it improved to 59% after occupational load specific exercise program. In group A, muscle power was 44% before conventional exercise program; whereas, it improved to 56% after conventional exercise program. In group B, muscle power was 40% before occupational load specific exercise program; whereas, it improved to 60% after occupational load specific exercise program.

Estimation of Musculoskeletal Impairments in Post Chikungunya Viral Infection

Chikungunya is common infectious disease in tropical countries characterized by fever and arthralgia. Following chikungunya viral infection, long term arthralgia is common chronic manifestation. We wanted to study its severity on musculoskeletal system in detail to plan early rehabilitative care to improve prognosis.METHODSThis is an observational study conducted among 66 subjects who had arthralgia post chikungunya fever. Subjects of both genders in the age group of 30 to 60 years fulfilling the inclusion and exclusion criteria participated. The outcome measure used was musculoskeletal assessment taking into consideration parameters of pain, ROM and oedema.RESULTSThe obtained results showed a significant prevalence rate in all three components i.e. pain, ROM and oedema. Pain was found to be present in 81% of subjects, preceded with altered ROM. Presence of oedema was noted in smaller values. Oedema was absent in 43% of subjects. In that 32% subjects had grade 1 oedema, 16% subjects had grade 2 oedema and remaining 9% had grade 3 oedema. Female subjects were found to have more profound impairments with greater pain levels and altered ROM.CONCLUSIONSMusculoskeletal impairments like pain, stiffness, oedema, impairment in joint range of motion, are present post chikungunya viral infection. Female subjects were found to have more pain and impaired ROM than the male subjects.