Translingual neurostimulation combined with physical therapy to improve walking and balance in multiple sclerosis (NeuroMSTraLS): Study protocol for a randomized controlled trial.

INTRODUCTION: Physical rehabilitation restores lost function and promotes brain plasticity in people with Multiple Sclerosis (MS). Research groups worldwide are testing the therapeutic effects of combining non-invasive neuromodulation with physical therapy (PT) to further improve functional outcomes in neurological disorders but with mixed results. Whether such devices enhance function is not clear. We present the rationale and study design for a randomized controlled trial evaluating if there is additional benefit to the synergistic pairing of translingual neurostimulation (TLNS) with PT to improve walking and balance in MS. METHODS AND ANALYSIS: A parallel group [PT + TLNS or PT + Sham], quadruple-blinded, randomized controlled trial. Participants (N = 52) with gait and balance deficits due to relapsing-remitting or progressive MS, who are between 18 and 70 years of age, will be recruited through patient registries in Newfoundland & Labrador and Saskatchewan, Canada. All participants will receive 14 weeks of PT while wearing either a TLNS or sham device. Dynamic Gait Index is the primary outcome. Secondary outcomes include fast walking speed, subjective ratings of fatigue, MS impact, and quality of life. Outcomes are assessed at baseline (Pre), after 14 weeks of therapy (Post), and 26 weeks (Follow Up). We employ multiple methods to ensure treatment fidelity including activity and device use monitoring. Primary and secondary outcomes will be analyzed using linear mixed-effect models. We will control for baseline score and site to test the effects of Time (Post vs. Follow-Up), Group and the Group x Time interaction as fixed effects. A random intercept of participant will account for the repeated measures in the Time variable. Participants must complete the Post testing to be included in the analysis. ETHICS AND DISSEMINATION: The Human Research Ethics Boards in Newfoundland & Labrador (HREB#2021.085) & Saskatchewan (HREB Bio 2578) approved the protocol. Dissemination avenues include peer-reviewed journals, conferences and patient-oriented communications.

Cross-Cultural Variation in BMI, Sedentary Behavior, and Physical Activity in International School Girls Residing in Saudi Arabia.

BACKGROUND: The current study was done to assess the cross-cultural difference in physical activity and sedentary behavior among girls from culturally, environmentally, and geographically diverse countries residing in Saudi Arabia. METHODS: This was a comparative cross-sectional study conducted among expatriate girls (N = 275), aged 9-16 years. Participants were from India (n = 65), Pakistan (n = 88), Egypt (n = 50), Sudan (n = 49), and other nationals (n = 23). They were randomly selected from different schools in Riyadh and their Body Mass Index (BMI) and screen time was assessed. Physical activity (PA) and leisure-time activity was assessed using Physical Activity Questionnaire for Older Children (PAQ-C) and the Godin-Shephard Leisure-Time Exercise Questionnaire (GSLTPAQ) respectively. RESULTS: Out of 275, 65.8% were active and 34.2% were insufficiently active as per the GSLTPAQ, and half of them were moderately active and only 22.2% were extremely active as per PAQ-C. No statistical significant differences in their BMI status, screen time, or the levels of PA among expatriate girls. CONCLUSIONS: This study shows that the expatriate female school children in Saudi Arabia demonstrated a similar pattern in their BMI, sedentary time spent, and PA levels.

Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey.

BACKGROUND: Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. AIM: To determine the current standard of ICU PT practice, attitude, and barriers. METHODS: A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. RESULTS: The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). CONCLUSION: PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

Sociodemographic factors associated with postpartum physical activity levels in working women.

Postpartum physical activity is important but is often neglected owing to conflicting priorities. Given the poor activity levels in the general Saudi population, women are especially likely to have poor postpartum activity levels. This study measured postpartum physical activity of Saudi working women and investigated the relationship between physical activity levels and sociodemographic factors. Study design: Cross-sectional study. This was a cross-sectional study conducted between January and June 2017. Working, postpartum Saudi women completed an online questionnaire including demographic information and the International Physical Activity Questionnaire (IPAQ)-short form. Of 486 women responding to the online invitation, 142 (29.2%) were eligible and participated. Based on IPAQ data, 23 (16.2%), 31 (21.8%), and 88 (62.0%) participants performed high, moderate or low levels of physical activity, respectively. No significant associations were found between the physical activity levels and sociodemographic factors. The most common factors discouraging physical activity were lack of time (21.2%) and childcare responsibilities (19.1%). The majority of participating working Saudi women had low postpartum physical activity levels. No sociodemographic factors were significantly associated with the level of physical activity. Measures may be required to promote postpartum physical activity among Saudi women.

Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy.

PURPOSE: Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP). MATERIALS AND METHODS: Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n = 15) or the control group (n = 14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30 minutes (pulse duration, 250 µs; pulse rate, 100 Hz) on the wrist extensors, once daily, 3 days a week, for 8 weeks, while the control group received traditional physical therapy. RESULTS: The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group. CONCLUSIONS: The use of TENS in combination with therapeutic exercise may improve strength and hand function.

Instruction prioritization in task-based balance training for individuals with idiopathic Parkinson's disease.

The objective of the study was to evaluate the effect of prioritization of instruction in balance training for individuals with Parkinson's disease (PD). Thirty-six participants were evaluated before and after the training using the Berg Balance Scale, Dynamic Gait Index, and Geriatric Depression Scale. Results show that dual task training with variable priority instruction is as effective as single task training in improving the balance performance of individuals with idiopathic PD.

Pedometer-determined physical activity levels of healthy children and children with Down's syndrome.

PURPOSE: Children with Down's syndrome (DS) are considered sedentary and less engaged in recommended physical activity (PA) levels. This study compared the PA levels between children with DS and healthy children in Saudi Arabia. METHODS: The study included 85 children divided into two groups. The DS group comprised 37 children with DS aged 8-12 years recruited from the Down Syndrome Charitable Association and Al-Nahda Schools for DS. The healthy group comprised 41 healthy children aged 8-12 years recruited from regular schools in the same region. PA levels were measured over 7 days using a pedometer. RESULTS: The healthy group was more active than the DS group (p < 0.05). The total PA steps per minute had significant differences between the DS (M = 7.979, SD = 2.21) and healthy groups (M = 17.512, SD = 3.08; p < 0.05). The daily step count differed significantly on weekdays and weekends between the groups (p < 0.05). CONCLUSIONS: The DS group had a high body mass index and physical inactivity compared with the second group. Obesity and physical inactivity among Saudi Arabian children with and without DS are major health concerns. Therefore, concerted efforts are needed to combat childhood obesity, promote PA, improve patient quality of life, and reduce the sedentary lifestyle among Saudi children and adolescents.

Effect of complete decongestive therapy and home program on health- related quality of life in post mastectomy lymphedema patients.

BACKGROUND: Secondary lymphedema is common in women treated for breast cancer. It may be a result of surgery or radiotherapy. Edema commonly affects the arm, leading to discomfort, reduced arm movements, pain and diminished quality of life. Therefore, the relationship between post mastectomy lymphedema and quality of life has evolved as an important criteria in treatment of breast cancer survivors. METHODS: Sixty breast cancer survivors who developed post mastectomy lymphedema were recruited. Patients were divided into 2 groups (n = 30) according to the treatment they received; Conventional therapy (CT) and Complete Decongestive Therapy (CDT) groups. Measurements were taken at baseline, 4 and 6 weeks. Health related Quality of Life was evaluated with the EORTC QLQ C30 and EORTC QLQ-BR23 questionnaires. Pain was measured using the Visual Analogue Scale. Descriptive statistics were used to analyze participant demographics and repeated measures of ANOVA was used for within and between group comparisons. RESULTS: Both groups showed improved quality of life and diminished pain after 6 weeks of treatment. However, greater improvement was observed in CDT group compared to the CT group. CONCLUSION: In this study, remedial exercises and home program in addition to manual lymphatic drainage and compression bandaging resulted in improved quality of life. Early identification of lymphedema and incorporation of remedial exercises and a home program improve the quality of life for breast cancer survivors. TRIAL REGISTRATION: Trial registry ID: ISRCTN13242080 , Date of registration: 7 April 2016.

Short-term sensorimotor-based intervention for handwriting performance in elementary school children.

BACKGROUND: Handwriting problems in childhood can have lifelong repercussions, affecting learning and career. Sensorimotor intervention therefore helps to alleviate these problems. METHODS: Thirty-one students (16 boys, 15 girls) underwent Minnesota Handwriting Assessment (MHA) to assess legibility, form, alignment, size, and spacing (the primary variables in this subject) as well as rate. Finally, 10 students (seven boys, three girls) aged 6-8 years (mean age, 77.1 ± 1.45 months) participated in an intervention program. Baseline MHA, Handwriting Proficiency Screening Questionnaire (HPSQ), and grip strength were measured. The same group of students acted as their own controls and were analyzed before the interventions and later after completion of the protocol. RESULTS: There was a significant improvement in MHA scores for legibility, form, alignment, size and spacing (P < 0.05), with the exception of rate. There were also significant changes in legibility, time performance and physical and emotional wellbeing domains in the HPSQ, and grip strength (P < 0.05, paired t-test). CONCLUSION: Short-term sensorimotor-based intervention produced significant improvements in the handwriting performance of elementary school children.

Impact of brisk walking and aerobics in overweight women.

[Purpose] Lack of physical activity and an uncontrolled diet cause excessive weight gain, which leads to obesity and other metabolic disorders. Studies have indicated that brisk walking and aerobics are the best methods for controlling and reducing weight and body mass composition. [Subjects and Methods] In this study, 45 overweight women were enrolled and divided into 3 groups. Women not involved in brisk walking or aerobics were included in group A (n = 15) as control subjects; women involved in brisk walking were in group B (n = 15); and those involved in aerobics were in group C (n = 15). [Results] This program was carried out 5 days/week for 10 weeks. Pre- and post-measurements of body mass index, waist and hip circumference, and skinfold thickness of the abdomen, subscapular area, biceps, and triceps were recorded for the women in all 3 groups. All values decreased in women who participated in brisk walking and aerobics for 10 weeks. [Conclusion] These results indicate that aerobics with diet therapy is a more effective intervention program for controlling and reducing body mass index and skinfold thickness than brisk walking with diet therapy in North Indian women.

Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema.

[Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema.

Predictors of global job satisfaction among Saudi physiotherapists: a descriptive study.

BACKGROUND AND OBJECTIVE: Job satisfaction is an important consideration in the recruitment and retention of physiotherapists (PTs). To date, the job satisfaction of PTs working in Saudi Arabia has not been investigated. The aim of this study was to measure the level of job satisfaction of PTs working in Saudi Arabia and evaluate predictors of job satisfaction. DESIGN AND SETTINGS: This was a cross-sectional observational study among licensed physical therapists working across 11 health care centers and university hospitals in Riyadh between 2013 and 2014. SUBJECTS AND METHODS: A total of 183 physical therapists participated in the survey. Level of job satisfaction and factors influencing satisfaction were explored using a purpose-designed job satisfaction questionnaire. It consisted of 8 survey domains, and the scores were normalized to allow between-domain comparison. RESULTS: Global job satisfaction was 37%. The highest levels of job satisfaction were seen in the domains of professional development and teamwork and the lowest levels of job satisfaction in the domains of supervisory/ management relationship (75%) and working environment (60%). Predictors of job satisfaction were gender (OR [odds ratio] 1.4, 95% CI 1.1-2.3), age (OR 0.7, 95% CI 0.5-0.9), relationships with supervisors and managers (OR 1.3, 95% CI 1.2-1.9), working environment (OR 1.2, 95% CI 1.0-2.3), and opportunities for professional development (OR 1.4, 95% CI 1.2-3.7). CONCLUSION: Saudi PTs were moderately satisfied with their job; strategies should be designed in such a way that they experience a high level of job satisfaction and retention thus resulting in improved rehabilitation services in Saudi Arabia.

Association between physical activity and psychological status among Saudi female students.

BACKGROUND: Physical inactivity is common among Saudi females. Many variables are associated with different levels of mental health, including physical activity. This study was designed to determine the correlation between 3 weeks of improved physical activity and psychological factors such as insomnia, depression and attention span. METHODS: Seventy-six female students, of mean age 20.9 ± 1.4 years, were analyzed. Insomnia, depression and attention were subjectively assessed using the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI), and the Attention Span Test (AST), respectively. Each subject was given a pedometers and advised to walk at least 6000 steps per day for 3 weeks. Psychological status was assessed before and after the 3 weeks and compared using paired sample t-tests. Pearson correlation was used to determine the association between physical health and psychological factors. RESULTS: Improvements in scores on the ISI (from 7.22 ± 3.06 to 4.09 ± 2.80), BDI (from 8.88 ± 3.13 to 3.98 ± 2.74) and AST (from 63.86 ± 3.06 to 77.27 ± 11.33) were observed after 3 weeks. Physical activity was negatively correlated with ISI (r = -0.74) and BDI (r = -0. 78) and positively correlated with AST (r = 0.69). CONCLUSION: Improved physical activity can be useful in managing insomnia, depression and attention. In female Saudi students, higher levels of physical activity were associated with improved mental health.

Effect of Different Positions on FVC and FEV1 Measurements of Asthmatic Patients.

[Purpose] The purpose of our study was to investigate the effect of different positions on pulmonary function test (PFT) values such as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) of asthmatic patients .[Subjects and Methods] Thirty subjects with severe asthma aged between 20-39 years were enrolled after they had signed a written consent. Subjects were selected using the inclusion criteria, and PFT were randomly administered. Spirometer measurements (FVC, FEV1) were taken in the supine, side lying on right, side lying on left, sitting and standing positions. Each measurement was taken three times, and the average values were analyzed. [Results] One- way analysis of variance (ANOVA) and Tukey's Test (post hoc) for pair- wise comparison indicated that there was a significant difference in the FEV1 values of the asthmatic patients however a significant difference was obtained between standing and supine positions. There was also a significant difference in the FVC values between the standing and supine lying position in the pair -wise comparison. [Conclusion] This study showed standing is the best position for measuring FEV1 and FVC of asthmatic subjects. The more upright the position, the higher the FEV1 and FVC will be.

Effect of therapy ball seating on learning and sitting discomforts among Saudi female students.

The aim of the study was to evaluate the effect of therapy ball seating as an alternative for typical chair seating in a classroom. We evaluated the effect of ball seating on the student's sitting discomfort and academic performance using Cornell Musculoskeletal Discomfort Questionnaire and problem-based learning scales, respectively. A sample of convenience was taken. Data was collected and analyzed using t-test. Subjects experienced a major discomfort at neck and a minor discomfort at knee joint. Results showed that there was a significant improvement (P ≤ 0.05) in sitting discomfort and student's performance when seated on therapy balls compared to typical classroom chairs. This study provides evidence for the effectiveness of therapy balls as a classroom seating for students who exhibit sitting discomfort and problem-based learning.

Treatment of knee osteoarthritis in relation to hamstring and quadriceps strength.

[Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity, gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA). [Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire (WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores, measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.

Association between Physical Activity and Insomnia among Saudi Female College Students.

[Purpose] Insomnia is quite common and it can affect the quality of life of an individual. Students undergo stress due to various academic demands leading to sleeplessness and daytime sleepiness. This study was conducted to investigate the association between physical activity and insomnia among female Saudi students. [Subjects] 62 female students with a mean age of 21 ± 1.5 years took part in a motivational program to increase the number of steps taken per day for three weeks. [Methods] After obtaining subject's informed consent all the subjects were assessed for insomnia using the insomnia severity index (ISI), They were then given pedometers to calculate the number of steps they took per day. A physical activity log was kept for three weeks. Pre- and post -intervention ISI scores were calculated and correlated with the 3-week physical activity log. [Results] 50% of the subjects had no clinically significant insomnia (NCSI), 42% had sub threshold (STI), and 8% had moderate clinical (MCI) insomnia. There was a moderate negative correlation between physical activity and ISI scores after the 3-week motivation program. [Conclusion] Prevalence of insomnia was common among female Saudi students and increase in physical activity appears to improve the sleep pattern.