Risk factors evaluation of cerebral palsy in Hazara division Khyber Pakhtunkhwa Pakistan: A cross-sectional survey.

OBJECTIVE: To evaluate the prevalence of risk factors of cerebral palsy in the mothers of children with cerebral palsy. Methods: The cross-sectional study was conducted in 2018 at the Helping Hand Institute of Rehabilitation Sciences, Mansehra, Pakistan, and comprised mothers of cerebral palsy children aged 1-18 years from the Hazara Division. Data was collected by using a modified form of Surveillance of cerebral palsy in Europe questionnaire regarding prenatal, natal and postal natal risk factors. Data was analysed using SPSS 21. RESULTS: Of the 300 children, 190(63.3%) were males and 110(36.7%) were females. The mean age of the children was 5.43±3.63 years and that of their mothers at the time of delivery was 26.16±5.11 years. Among the prenatal risk factors, anaemia was the leading factor 179(59.6%), while delayed crying 187(63.3%) was the major postnatal factor. Consanguinity was reported by 200(66.7%) mothers. Majority of the deliveries 201(67%) had taken place at hospitals. Conclusion: Anaemia and delayed crying were the major risk factors identified in mothers and children, respectively, in the study sample.

Comparison of the effectiveness of novel intervention on restricted range of motion of shoulder in young healthy subjects.

OBJECTIVE: To evaluate the effectiveness of four novel and pragmatic interventions on the restricted range of motion (ROM) of shoulder joint in healthy subjects. METHODS: The study was conducted at Helping Hand Institute of Rehabilitation Sciences, Mansehra, in 6-months duration. This quasi-experimental study recruited 120 young subjects with an equal proportion of males and females for four novel intervention groups (n=30 each group) including pragmatic posterior capsular stretch, Serratus anterior stretch, rotator cuff facilitation and acromioclavicular joint mobilization. Study variables included measurement of Reaching up behind the back (RUBTB), Reaching down behind the neck (RDBTN), and shoulder range of motion (flexion, abduction, external rotation, internal rotation). The paired t-test was used for the change in pretest and posttest variables and the Kruskal Wallis test was used to compare the change in each group of interventions. RESULTS: All the variables improved significantly (p< 0.05) from their baseline scores for the interventions. The mean difference among the intervention groups for the variables was statistically significant (p<0.001) on the Kruskal Wallis test. Pragmatic posterior capsular stretch (PPCS) and serratus anterior stretch (SAS) improved the RUBTB and RDBTN more than the other interventions. Rotator cuff facilitation (RFC) improved shoulder rotation more than the rest of the intervention. Acromioclavicular joint mobilization (ACJM) was effective in improving the abduction and flexion ROM. CONCLUSION: Pragmatic interventions are effective in improving shoulder ROM in young healthy adults and recommended for the trials on prevention and rehabilitation of shoulder pathologies.

Serratus Anterior Stretch: A Novel Intervention and Its Effect on the Shoulder Range of Motion.

CONTEXT: Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. OBJECTIVE: To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. METHOD: This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11) m, and weight 60.90 (10.36) kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. RESULTS: A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P < .000). The change in internal rotation was 6.00° (7.47°), external rotation was 5.66° (9.35°), abduction was 13.50° (11.82°), flexion was 20° (13.33°), reaching up behind the back was 5.10 (2.21) cm, and reaching down behind the neck was 5.41 (2.89) cm. The most marked improvement was in reaching up behind the back (24.48%) and reaching down behind the neck (22.78%). A very large effect size (>1) was observed across most of the variables. CONCLUSION: An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility.

Pragmatic posterior capsular stretch and its effects on shoulder joint range of motion.

OBJECTIVE: To evaluate the immediate effects of pragmatic posterior capsular stretch (PPCS) on shoulder joint range of motion (ROM). METHOD: A quasi-experimental design was used to recruit healthy subjects of age 21.43 (±1.960) years, height 165.8 (±2.1069) cm and weight 63.90 (±13.187) kg. Inclusion criteria were grade 1 and grade 2 of the shoulder mobility test of functional movement screening. Preintervention and postintervention measurement of flexion, abduction, internal rotation (IR), external rotation (ER), reaching up behind the back (RUBTB) and reaching down behind the neck (RDBTN) were compared. A therapist-administered PPCS was the only intervention applied. RESULTS: Paired t-test statistics showed improvement (mean°±SD) in shoulder flexion (13.5°±8.11), abduction (11°±8.35), IR (8.5°±10.27), ER (7.83°±7.15), RUBTB (17.34°±13.81) inches and RDBTN (2.93±1.52) inches. The changes in these ROM and functional movements were statistically significant (p<0.05). CONCLUSION: PPCS can effectively improve the functional movement of RUBTB and shoulder ROM in healthy subjects. It is recommended for the trials on prevention and rehabilitation of shoulder pathologies. TRIAL REGISTRATION NUMBER: NCT04242888.

An unusual effect of interferential therapy.

In this report, a patient with severe shoulder pain was treated with interferential currents, a commonly used modality in physiotherapy for the management of pain. He reported loss of concentration, drowsiness, decreased alertness and gait disturbance, along with analgaesia, for 4-5 h after each treatment. He was regularly taking tramadol HCl for pain relief. Endogenous opioids produced in response to interferential therapy may be excessive or may interact with the tramadol HCl and potentiate its effect. There is no published report of interferential-induced symptoms, as described above, in the authors' knowledge. The clinician using interferential currents should be aware of this possible effect.

Safe physiotherapy interventions in large cervical disc herniations.

A 34-year-old woman was seen in a physiotherapy department with signs and symptoms of cervical radiculopathy. Loss of cervical lordosis and a large paracentral to intraforaminal disc prolapse (8 mm) at C5-C6 level was reported on MRI. She was taking diclofenac sodium, tramadol HCl, diazepam and pregabalin for the preceding 2 months and no significant improvement, except temporary relief, was reported. She was referred to physiotherapy while awaiting a surgical opinion from a neurosurgeon. In physiotherapy she was treated with mobilisation of the upper thoracic spine from C7 to T6 level. A cervical extension exercise was performed with prior voluntary extension of the thoracic spine and elevated shoulders. She was advised to continue the same at home. General posture advice was given. Signs and symptoms resolved within the following four sessions of treatment over 3 weeks. Surgical intervention was subsequently deemed unnecessary.