Correlation between fear of fall, balance and physical function in people with osteoarthritis of knee joint.

Introduction: Osteoarthritis is a degenerative joint disease. Fear of fall and balance impairment in people with osteoarthritis of knee joint is a major cause of loss of independence, which has an effect on the physical function in them. The aim of the study was to correlate fear of fall with balance scores and with physical function in people with osteoarthritis of knee joint. Material and methods: A correlational study was conducted at college of physiotherapy where fear of fall, balance impairment and physical function were assessed in 30 subjects, both males and females, diagnosed having osteoarthritis of knee joint. Exclusion criteria were subjects with history of neurological diseases, fracture or total joint replacement within the previous 6 month or acute illness or injury on the day of the functional assessment. Outcome measure includded Fear of fall measured using falls efficacy scale-international (English) (FES), balance was measured using Berg balance scale (BBS) and physical function was assessed using modified WOMAC index (CRD pune version). Level of significance was kept at 5%. Spearman correlation was applied to find the correlation between FES and BBS and between FES and WOMAC. All the data were analyzed using SPSS16. Results: A moderate negative correlation was found between FES and BBS (r=0.520, p=0.002) and a positive moderate correlation between FES and WOMAC (r=0.666, p<0.001) which were significant. Conclusion: The study concluded that there is a correlation between fear of fall and balance and physical function in subjects with osteoarthritis of knee.

Comparison of speed of walking with and without visual distraction in subjects with Osteoarthritis of knee.

Introduction: Knee osteoarthritis (OA) is a major public health problem. Knee OA leads to impaired balance and reduction in speed of walking, which is accentuated under dual-task conditions. Walking relies on continuous visual processing to obstacles as one navigates through a visually defined environment. Objectives: The study aimed to compare the speed of walking with and without vis subjects with OA knee and with normal individuals. Material and methods: Fifteen subjects with OA knee and 15 without OA knee of same age and gender were selected. Subjects were selected according to inclusion and exclusion criteria. Experiment was carried out over straight path of 50 m length and 2.5 m width. Subjects walked on two consecutive days at preferred speed 3 times back and forth covering total distance of 300 m. Charts were shown on either of the two days. Subjects passed 12 times through charts of various objects held by two assistants. Some objects were kept upright or inverted and subjects needed to reply by saying ‘yes’ or ‘no’. Charts of various colors were also shown and they were asked to identify them. The speed was noted. They also walked same distance without distraction. Level of significance will be kept at 5%. Results: Wilcoxon test was used for within group analysis for speed of walking with and without distraction. Significant difference was seen for both subjects with OA knee (W= 2.897, p=0.004) and normal subjects (W=-3.266, p=0.001). Mann Whitney U test was used for between groups analysis. With distraction groups showed significant difference (W=2.219, p=0.026). But there was no significant difference in analysis in between groups without distraction (w=-1.701,p=0.089). Conclusion: Visual distraction leads to reduction in speed of walking in subjects with OA knee as compared to normal subjects.

Correlation between aerobic capacity and fatigue in subjects with post- polio syndrome.

Introduction: Post-polio syndrome (PPS) is defined by Halstead and Ross as having a period of at least 15 years of neurologic and functional stability followed by onset of two or more of the following new health problems: unexplained fatigue, muscle or joint pain, muscle weakness, and cold intolerance and exclusion of other medical diagnosis. Fatigue occurs in 59-89% of PPS patients.Aerobic capacity during functional activities may also decrease in subjects with PPS which may lead to fatigue or vice versa. This study aimed to correlate the aerobic capacity using the 2 minute walk distance (2MWD) with fatigue using Fatigue Severity Scale (FSS) in subjects with PPS. Material and methods: An observational study using convenience sampling was conducted in a community setting, in Surat on 19 individuals with PPS. Inclusion criteria were according to the old Halstead criteria and individuals who were able to walk with and without walking aids. Individuals who were on psychotropic medications, a diagnosed respiratory or cardiac condition, who were uncooperative due to cognitive impairment and those who were unwilling to participate were excluded. Outcome measures were Two Minute Walk distance (2MWD) for aerobic capacity and Fatigue Severity Scale (FSS) for fatigue. The subjects were asked to fill a questionnaire which included their demographic data and the Fatigue Severity Scale. They were asked to walk on a25 m long corridor as far as they could, for 2 minutes. They were explained that if they felt breathless or fatigued, then they could stop. At the completion of 2 minutes, distance was recorded. Results: The mean 2MWD was 76.02±1.37 m and FSS was 40.25±3.50. The value of Spearman’s correlation coefficient was -0.46 (p=0.48).The study shows moderate correlation between FSS and 2MWD which was statistically significant. Conclusion: Fatigue influences the aerobic capacity of subjects with post- polio syndrome and vice versa.

Comparison of effect of different sensitizing manoeuvres on Slump test in patients with low back pain having normal and overweight Body Mass Index.

Introduction: Slump test, a neurodynamic test, is used to test mechanical movement of the neurological tissues and to test their sensitivity to mechanical stress. Various studies have found that neural tissue mobility differs in normal young adults with different body mass index (BMI). This study aimed at finding out whether the neural mobility is different in patients with different BMI having low back pain with or without radiculopathy. Objective: To compare the effect of different sensitizing manoeuvres on slump test in patients with low back pain having normal and overweight BMI. Material and methods: 30 patients having low back pain with or without radiculopathy were divided in two groups, one group (A) had patients with underweight and normal BMI and the other group (B) had overweight and obese subjects. Patients with conditions like infection, tumour, osteoporosis, spinal surgery and pregnancy were excluded. The outcome measure used was the popliteal angle, The readings were taken in four positions namely cervical spine neutral with ankle neutral, cervical spine neutral with ankle dorsiflexion, cervical spine flexion with ankle neutral, and cervical spine flexion with ankle dorsiflexion and were compared on both the sides. Thoracic and lumber spine was maintained in flexion in all positions. Level of significance was kept at 5%. Results: The difference in the means of popliteal angle deficit score on both the right and left sides between groups A and B in all four positions was found to be significantaly significant. Conclusion: Neural tissue extensibility is reduced in overweight and obese patients with low back pain compared to the patients having normal and underweight BMI.

Effect of hippo therapy on balance and function in children with spastic diplegia.

Introduction: Hippo therapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse. The horse's pelvis has a similar three dimensional movement to the human's pelvis at the walk. This movement provides physical and sensory input which is variable, rhythmic and repetitive which leads to improvement in spasticity and balance. Objective: The study aimed to find the effect of hippo therapy on balance and function in children with spastic diplegia Material and methods: A quasi-experimental study was conducted at College of Physiotherapy, Ahmadabad. Sixteen children (8 in control group (A) and 8 in experimental group (B) with spastic cerebral palsy, aged 3 to 10 years with GMFCS level 1, 2, body weight less than 35 kg were include. Children with history of botulism toxin injection within 6 months, selective dorsal rhizotomy or orthopedic surgery within 1 year, moderate to severe intellectual disability, uncontrolled seizures, and poor visual or hearing acuity were exclude. Both groups were given neuro developmental technique (NDT), group B was given additional hippo therpy (riding on horse with minimal support as required) for 15 minutes twice a week. Outcome measures were Pediatric balance scale (PBS), GMFM 66, 88, Modified Ashworth scale. Level of significance was kept at 5%. Result: Within group, analysis did not show significant difference in PBS score ( W2.214, p = 0.027). Within group analysis for group B showed significant difference in both GMFM score (W= 2.207, p = 0.027) and PBS score (W = 2.214, p = 0.027). Between group analysis for GMFM score showed significant difference (U = 0.500, p = 0.005). But there was no significant difference in between group analysis for PBS score (U = 12.00, p = 0.321). Conclusion: Hippo therapy and NDT both have similar effect for improving balance in spastic diplegic children. But Hippo therapy has an additional effect for improving gross motor function.

Effect of electrical stimulation on facial grading system in subjects with early facial palsy.

Aim and Purpose: Most patients with facial palsy experience spontaneous recovery by 3 weeks to 3 months. As electrical stimulation is a popular intervention the study was conducted to explore it as an option for enhancing recovery in patients with facial palsy. So the aim of the study was to determine the potential efficacy of applying electrical stimulation to facial nerve trunks in early phase of facial nerve palsy of idiopathic onset. Methodology: The study design was a pretest – post test control V/S experimental group, with a sample size of 50 subjects. Convenient sampling was used and subjects were randomly allocated into two groups. The outcome measure used was the Facial Grading System Score (FGS). The inclusion criteria were males and females aged 15-65 years with a clinical diagnosis of lower motor neuron facial palsy of idiopathic origin of less than 7 days onset. The exclusion criteria were subjects with a known cause of facial palsy with onset less than 7 days. Group A was given heat in the form of Infra Red to the ear and face on affected side for 10 minutes for 1 week. Electrical Stimulation for next 3 weeks to affected facial nerve trunk branches was then given. Parameters used were Surged Faradic Current with pulse duration 0.1ms, pulse frequency 50 Hz, and surge duration: interval ratio was 5:5. Intensity was increased to produce mild contraction of facial muscles stimulated at nerve trunk branch. 15 contractions daily were given. Both Group A and B subjects were explained the condition, taught exercises, and given advices about care required. Subjects in group B were asked to follow up after 4 weeks. Data was analyzed using SPSS. Level of significance was kept at 5%. Results: For group A and B difference in mean values of facial grading system scores at end of 4 weeks was found to be statistically significant (z=4.861, z= 4.016 respectively, p < 0.001). However at the end of 4 weeks difference in median values between the groups was not found to be statistically significant (z=0.420, p=0.675) Conclusion: Outcome demonstrates neither benefit nor harm with electrical stimulation in subjects with early facial palsy.