Effect Of Manual Therapy (MET) Vs Conventional Therapy For Improving Tendo-Achilles (TA) Flexibility And Foot Posture In Children With Autism Spectrum Disorder

Background: Autism Spectrum Disorder (ASD) is a disorder of neurodevelopment, which affects individuals across social, ethnic, and geographic groups. Autistic children have difficulty with gross motor and fine motor functioning difficulties, including a wide range of signs and symptoms. Toe walking due to TA tightness is commonly observed gait in autistic children altering foot posture in them. The knowledge about the abnormalities can be useful for the assessment and treatment planning of ASD children. We evaluated TA tightness, ROM of the ankle joint, and compare the effect of manual therapy (MET) and conventional therapy for improving TA flexibility and foot posture. Methods: An RCT included 20 diagnosed autistic children(13male,7female) as per inclusion criteria the subjects were divided into two groups, i.e., group A and B, the group A was given Conventional Therapy in the form of passive stretching whereas Group B was given Manual Therapy in the form Muscle Energy Technique. The participants were clinically examined and evaluate TA tightness in the form of Elastography, Range of motion, and foot posture. Data were taken as pre and after post-intervention. Results: There were significant changes in elastography readings, foot posture index, and range of motion in both groups post-intervention, but significant improvement was observed in group B as compared to group A, i.e., p>0.05. Conclusion: This has been concluded that there is a significant effect of Manual therapy in the form of muscle energy technique for improving TA flexibility and foot posture as compared to conventional treatment.

COVID-19 Pandemic- A Curse to the Physical Well-Being of Every Individual in Lock-Down

The 2019 novel coronavirus (COVID-19) has rapidly spread from its origin in Wuhan City of China to other countries. In response to the rapid spread of COVID-19, preventive measures such as social distancing have resulted in the global closure of all means of entertainment or recreational activities. Owing to the lockdown phase and more tendencies for sedentary lifestyle than earlier, there is a higher probability of the population to suffer from musculoskeletal issues during this phase. This can further result in various physical health issues in terms of reduced endurance, reduced muscle strength, obesity, and metabolic problems associated with decreased physical activity (PA), etc. Aerobic exercise has shown that the peripheral number of lymphocytes in the blood is significantly raised; precipitating the idea that exercise helps to "stimulate" the immune system during exercise. PA has various health benefits including reduced incidence of disease and decreased systemic inflammation. A physically active lifestyle has a direct impact on an individual's state of well-being, quality of life, and cognitive function. Thus, PA is related to a decreased chance of cognitive decline and dementia. Previous studies have shown that daily PA leads to lower death rates and infection incidence rates. Both physical activity and exercise are positively related to beneficial metabolic and immunological health outcomes. Besides, they have proven to be effective with direct effects on physical health for most of the chronic diseases. Routine exercises improve the improve physical wellbeing. Therefore, individual prescription and guidance are required to establish an effective exercise program aimed in sustaining or enhancing the key health-related components of physical fitness. This article gives an overview of the musculoskeletal awareness in lockdown phase owing to increased sedentary lifestyle during the lockdown phase.

Impact of Physiotherapy Rehabilitation Program on Post-Operative Stiffness of Supraspinatus Tendinitis.

In the general population, shoulder pain is a common musculoskeletal problem. Older people are frequently affected, and the most common causes of shoulder pain are the problems with rotator cuffs which are seen in primary care practice. The incidence of rotator cuff tear increases with advanced age and it has been estimated that the prevalence of shoulder pain in older patients ranges from 21% to 27%.(1)Tendons are thick, fibrous tissues that transmits muscle-generated force to the bones and thus generates joint movement. Repeated activities and complex muscle-tendon overuse can damage tendons that lead to pain and decrease function.(2)The supraspinatus muscle is a part of the rotator cuff of shoulder.(3) The inflammation of a muscle tendon causes tendinitis and it has varying levels of pain. Supraspinatus tendonitis is an inflammation of supraspinatus tendon often associated with shoulder impingement syndrome.(4) The Supraspinatus tear that causes the supraspinatus tendon to affect the acromion leading to pain is the cause of Supraspinatus Tendinitis. The main cause of the Supraspinatus tear is constant pressure, increased workload and wear and tear associated with age.(5)Total loss of active abduction at the glenohumeral joint is due to a complete tear of supraspinatus.(6) Supraspinatus tendonitis complications include leading to a rotator cuff tear. Initially, rotator cuff tears were almost identified as secondary to tendon haemorrhage and tendonitis products of untreated impingement.(7)The primary purpose of rehabilitation to achieve short-term and long-term goal, patient education and consistent plan of care. The patient's awareness on the need to take non-operative steps, improvement, and the availability of choices will assist them in being active participants in their treatment.(7)

Impact of Physiotherapy Rehabilitation on Patients with Bilateral Osteoarthritis Knee Pain - A Case Report.

Osteoarthritis (OA) is a severe joint disease that affects more than 60 per cent of the elderly. Primary OA pathogenesis is an intrinsic cartilage disorder in which biomechanical and metabolic changes contribute to its breakdown. Although OA is a phase of multifactorial disease, early cartilage damage, and ultimate loss of articular cartilage are considered essential for OA progression. Other essential pathophysiology of OA is bone or joint deterioration, in addition to cartilage degeneration. Although multiple accounts of joint deformity such as osteophytes, subchondral osteosclerosis and bone cysts have been found to be important pathological hallmarks for OA.(1)As life expectancy increases and the age at which patients are diagnosed with knee OA decreases, exploring alternative therapies for treating knee OA becomes necessary. The aim of this case study is to identify a conservative approach to treatment with physical therapy to relieve symptomatic OA pain in the knee and to achieve functional results.(2)The patient was a 53 year old male with complaints of pain in right and left knee joint while walking, standing for extended periods of time, and also while performing functional activities of the affected joint. The aim of physiotherapy for the patient was to return the patient to normal functional activities. After completion of physiotherapy, the patient showed minor changes in the range of motion of right and left knee flexion within functional limits, improvement in strength of both the knee joint muscles and independence in completing a home exercise program. Pain was also decreased according to numerical pain rating scale.

Telehealth - A Boon in the Time of COVID 19 Outbreak.

Since December 2019, a novel coronavirus, SARS-CoV-2, has been identified in a group of community acquired pneumonia patients in Wuhan, Hubei Province, China.(1) Within one month of its discovery, this novel coronavirus was rapidly spreading in all regions of China and 25 countries in Asia-Pacific region, Europe, and South America, North America. With the COVID 19 pandemic rapidly spreading in India and the world, it is imperative that the rehabilitation team understands virus’s epidemiology quickly at the beginning stages of this certainly long global epidemic. Coronavirus is a novel virus, and it has no known immunity for most of the world population. This is more contagious and lethal than influenza viruses, and effective medication and a vaccine are months away. Our strategy against this is primarily social distancing and interventions to manage infections.

Paradigmatic Shift in the Education System in a Time of COVID 19.

The rapid spread of COVID-19 worldwide in 2019 – 2020 has had a great impact on educational institutes. Global closure of educational institutions to maintain social distancing and isolation has led to a gap in learning and development. Prolonged closures can lead to interrupted learning, parents’ unpreparedness for distance learning, and home schooling, gaps in childcare, unequal access to digital learning portals, increased pressure on education systems that remain open, and probable chances of a rise in dropout rates and social isolation. Most institutions, globally, in the affected areas, are looking for stop-gap solutions to carry on teaching, and the factor significantly affecting the quality of learning is the level and quality of digital access. Digitalization being big evolutionary step, will reshape the entire education system in future. Digitalization has changed the course of distance learning leading to online computer-based learning. COVID 19 pandemic brought about a new paradigmatic shift in learning from frontal education system to online digital learning, thus bringing about a truly new learning experience.In response to the rapid spread of COVID-19, preventive measures such as social-distancing and self-isolation have resulted in the global closure of educational institutions.(1) Since educational institutes are hubs of social activity and human interaction, their closure has led to a lack of social contact among children and youth, which is essential to learning and development. School closures are critical social distancing tools to mitigate the spread of the disease and avoid an increase of cases, thus reducing the strain on health services. While closures of educational institutes appear as a logical solution to achieve social distancing within communities, prolonged closures tend to produce a negative impact on most students, such as interrupted learning, parents unpreparedness for distance learning and home schooling, gaps in childcare, unequal access to digital learning portals, increased pressure on education systems that remain open, and a probable chance of a rise in dropout rates and social isolation.

Quarantine Exercises in the Time of Covid-19- A Review.

Coronavirus disease 2019 (Covid-19) originating in Wuhan, China in December2019 spread worldwide rapidly. It was declared as a global public healthemergency, and subsequently as a pandemic by the WHO, owing to its worldwidespread. Currently, Covid-19 is of the gravest concern because of its hightransmissibility, high mortality, rapid global spread, lack of knowledge about thedisease and lack of management resources. Lockdown and self-quarantinemeasures have been implemented globally by various nations to mitigate the spreadof Covid-19. In several nations, fitness centres and other public places, wherepeople are normally active, had been temporarily closed to prevent further spreadof infection. Being quarantined at home for extended periods makes it challengingto stay physically active. Recent studies demonstrated that regular physicalactivities and exercises lower the incidence of several communicable diseases,including the novel Covid-19 by enhancing the immune system. Regular exercisesimprove the components of physical fitness, which include muscular strength,cardiorespiratory fitness, coordination, balance and agility, which in turn, enhancethe physiological functions of the body. Regular exercises and relaxation techniquesare some significant approaches aimed at improving one’s overall health during thequarantine. Since organizations and governments worldwide had advised physicalactivity in quarantine, and also because regular physical activity is beneficial forboth the physical and mental health, its role in the quarantine is significant. Thisreview highlights the significance of physical activity and exercise in enhancing thewell-being of individuals during the quarantine phase of Covid-19 pandemic.

Physiotherapy Approach towards a Typical Case of Injection Induced Radial Nerve Palsy Presenting as Wrist Drop.

Wrist drop occurs as a consequence of radial nerve palsy. From the estimates, it is found that each person receives at least two injections annually in the developing countries, and 50 percent of these injections are not considered safe.(1) Unfortunately, trauma to peripheral nerves isn't unusual in our country. Though reliable statistics are not available at the national level, the incidence of injury to peripheral nerves, especially to radial nerve, is on the rise, largely due to increased road traffic accidents and increased violence in our society as a whole.(1) Radial Nerve damage occurring as a consequence of intramuscular injection application is comparatively less common than sciatic nerve injury.(2) When therapeutic and prophylactic agents are applied in the form of intramuscular injections into buttock and arm, occasionally damage to the peripheral nerves can occur. Those whose radial nerve function has been compromised would not be able to actively extend extensor muscles of the wrist and digits since the radial nerve innervates them. As a result, the hand hangs flaccidly in a flexed position when the patient attempts to move the arm to a horizontal position. Patients may also experience paraesthesia, hypoesthesia, numbness and other sensory disturbances. Simple, pain-free sensory deficits may be functionally less significant because they involve the anatomical snuffbox and the radial dorsum of the hand. Injury to radial nerve results in motor function impairment leading to weakness during extension of the forearm, wrist, and fingers. However, wrist extension may be relatively spared because common radial nerve innervates the extensor carpi radialis longus muscle proximal to its division.(3)The inability of a person to extend his wrist and/or fingers due to the above mentioned causes is called "wrist drop" or "finger drop."(4) The other causes of wrist drop include stab wound injury to shoulder area where the terminal branch of posterior cord of brachial plexus is given off as radial nerve and any agent causing persistent injury to nerve. Interventions for wrist drop include splinting, electrical stimulation, exercises for hand and fingers, surgery, and drug therapy. The present case is diagnosed with Wrist Drop caused due to the injection induced injury to the radial nerve of left side. Needle length recommendation is very important before inducing the injection in male and female.(4)In the developing countries, common diseases are treated with the application of injections. When therapeutic and prophylactic agents are applied in the form of intramuscular injections into buttock and arm, occasionally damage to the peripheral nerves can occur. There are various reasons for the injury to the peripheral nerves. In case of wrist drop, reasons for the injury to the radial nerve may be gun-shot injury, humeral shaft fracture, misplaced injection and compression or ischemia

Advance Physiotherapeutic Rehabilitation Approach for Hand Functions in a Giant Cell Tumour Patient- A Case Report on Palliative Physiotherapy

Giant cell tumour is a benign tumour of the bone. It is aggressive locally and has low metastatic potential.(1) Following lower end of femur and upper tibia, distal end of radius is the third most evident location for giant cell tumour (GCT) and about 10 percent of GCT involves distal radius.(2) GCT have often been identified as difficult to manage, mainly due to their close proximity to multiple tendons, median nerves, radial arteries and carpals.(3) Surgical treatment includes extended curettage of bone and replacing the cavity with bone graft, or excision of the tumour followed by reconstruction of bone with autograft or allograft.(1) Wrist fusion after ulnar translocation results in reduced range of pronation and supination movements in the forearm initially and mainly flexion and extension of the wrist joint, lag of the extensor pollicis brevis and longus tendons, abductor pollicis longus, stiffness and the risk of infections at the site.(6) Physiotherapy has been shown to be effective in the post-surgery treatment of patients. Nonetheless, the therapeutic program involves passive movement to active movements, manual joint mobilization, progressive resisted exercises, muscle energy technique and electrotherapy with adequate patient education. This has been shown to help improve patient outcomes and alleviate pain and recover full range of motion.(7)The distal end of the radius is the third most apparent site for giant cell tumour (GCT) after the lower end of the femur and upper tibia and about 10 per cent of GCT includes distal radius. After ulnar translocation and wrist arthrodesis the full range of motion cannot be regained at the wrist joint and which makes the case unique, physical therapy has been shown to be helpful for improving patient performance and quality of life in post-surgical situations. Patient main concerns were pain and oedema around wrist with loss of strength, power and range of motion. Main clinical findings found in this case were severe reduction in of range of motion at CMC, MCP and IP joints. Reduced strength in hand muscles. Loss of superficial sensation over C6, C7 in affected extremity (right). Giant Cell Tumour that was confirmed by X-Ray and histopathology as well as MRI. Nerve injury confirmed by Nerve Conduction Velocity. Therapeutic interventions are found to be beneficial in these type cases. The patient was able to achieve 4/6 activities of daily living and gain functional range of motion after continuous 10 weeks of intensive systematic physiotherapy treatment program.