Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy.

Introduction. Cerebral palsy (CP) is caused by an injury to the developing brain, and abnormal gross motor function is a hallmark of CP. Properly structured exercises on land have been reported to be effective in improving functional performance in children with CP while only few have been documented on aquatic therapy. Objective. To investigate the effect of a 10-week aquatic exercise training program on gross motor function in children with spastic CP. Methods. Thirty participants aged 1 to 12 years were randomized into the experimental and control groups. Both groups received manual passive stretching and functional training exercises, depending on their level of motor impairment, either in water (temperature 28°C to 32°C) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurement of gross motor function was done using Gross Motor Function Measure (GMFM-88) at baseline and after 4 weeks, 8 weeks, and 10 weeks of intervention. Both groups were compared for differences in change in gross motor function using Mann-Whitney U test. The level of significance was set at P < .05. Results. Only the experimental group showed significant improvement (P < .05) in all dimensions of gross motor function except for walking, running, and jumping (P = .112). Statistically significant difference (P < .05) was found between both groups for all dimensions of gross motor function after 10 weeks of intervention. Conclusion. Aquatic exercise training program is effective in the functional rehabilitation of children with spastic CP.

Characterisation of physiotherapy needs in a rural community in South Eastern Nigeria.

BACKGROUND: The majority of the populace in Nigeria resides in rural areas, where there is difficulty in accessing rehabilitation services. Rural dwellers are often poor and marginalized, and have been reported to have a high level of disability and functional dependence. They may therefore be in need of rehabilitation. OBJECTIVE: To assess and characterize physiotherapy needs in a rural community of South Eastern Nigeria. METHODS: A total of 400 individuals participated in this population-based cross-sectional study which included 'household members' aged 0-5 years and 12 years and above, involving 12 randomly selected villages from Nkanu West Local Government of South Eastern Nigeria. Distribution of the questionnaire was done by hand on a one-on-one basis, using the interviewer style. Information on infants and children was obtained from the heads of the households. RESULTS: One hundred and ninety six (49.0%) reported ambulatory problems; the problem were mostly associated with the spine 75 (18.8%), multiple joints 51(12.8%) and lower limbs 43 (10.8%) respectively. The highest developmental deficit was reported at three years 6 (18.7%). CONCLUSION: There is need to provide affordable community based rehabilitation (physiotherapy) outfits in this community.

Insoles for prevention and treatment of back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the effectiveness of shoe insoles in the prevention and treatment of nonspecific back pain compared with placebo, no intervention, or other interventions. SUMMARY OF BACKGROUND DATA: There is lack of theoretical and clinical knowledge of the use of insoles for prevention or treatment of back pain. METHODS: We searched electronic databases from inception to October 2008. We reviewed reference lists in review articles, guidelines, and in the included trials; conducted citation tracking; and contacted individuals with expertise in this domain. One review author conducted the searches and blinded the retrieved references for authors, institution, and journal. Two review authors independently selected the relevant articles. Two different review authors independently assessed the methodological quality and clinical relevance and extracted the data from each trial using the criteria recommended by the Cochrane Back Review Group. RESULTS: Six randomized controlled trials met inclusion criteria: 3 examined prevention of back pain (2061 participants) and 3 examined mixed populations (256 participants) without being clear whether they were aimed at primary or secondary prevention or treatment. No treatment trials were found. There is strong evidence that the use of insoles does not prevent back pain. There is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities. CONCLUSION: There is strong evidence that insoles are not effective for the prevention of back pain. The current evidence on insoles as treatment for low back pain does not allow any conclusions.

Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as a therapeutic adjunct to the pharmacological management of pain. However, despite widespread use, its effectiveness in chronic low-back pain (LBP) is still controversial. OBJECTIVES: To determine whether TENS is more effective than placebo for the management of chronic LBP. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro and CINAHL were searched up to July 19, 2007. SELECTION CRITERIA: Only randomized controlled clinical trials (RCTs) comparing TENS to placebo in patients with chronic LBP were included. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials, assessed their methodological quality and extracted relevant data. If quantitative meta-analysis was not possible, a qualitative synthesis was performed, taking into consideration 5 levels of evidence as recommended by the Cochrane Collaboration Back Review Group. MAIN RESULTS: Four high-quality RCTs (585 patients) met the selection criteria. Clinical heterogeneity prevented the use of meta-analysis. Therefore, a qualitative synthesis was completed. There was conflicting evidence about whether TENS was beneficial in reducing back pain intensity and consistent evidence in two trials (410 patients) that it did not improve back-specific functional status. There was moderate evidence that work status and the use of medical services did not change with treatment. Conflicting results were obtained from two studies regarding generic health status, with one study showing no improvement on the modified Sickness Impact Profile and another study showing significant improvements on several, but not all subsections of the SF-36 questionnaire. Multiple physical outcome measures lacked statistically significant improvement relative to placebo. In general, patients treated with acupuncture-like TENS responded similarly to those treated with conventional TENS. However, in two of the trials, an inadequate stimulation intensity was used for acupuncture-like TENS, given that muscle twitching was not induced. Optimal treatment schedules could not be reliably determined based on the available data. Adverse effects included minor skin irritation at the site of electrode placement. AUTHORS' CONCLUSIONS: At this time, the evidence from the small number of placebo-controlled trials does not support the use of TENS in the routine management of chronic LBP. Further research is encouraged.