Journal of Modern Rehabilitation

Non-Surgical Management of Disc-Related Low Back Pain: An Algorithmic Approach and Practical Guideline

2024-07-01T16:25:34+00:00

Introduction: Low back pain (LBP) is a common health problem worldwide and the primary cause of years lived with disability. Studies on the non-surgical management approaches for disc-related LBP are sparse and scarce, so a clear and structured guideline in this area would be useful. This study summarizes the non-surgical management approaches for disc-related LBP in a review.

Materials and Methods: Intervention studies and review articles relating to the non-surgical approaches for disc-related LBP treatment were curated from PubMed, EMBASE, Cochrane, and Google Scholar databases before July 1, 2022.

Results: Several management approaches are suggested in the studies for disc-related LBP, including medications, acupuncture, lumbar orthoses, exercise therapy, manual therapy, physical therapy modalities, and spinal injections. Some of these options have been studied more, like exercise therapy and injections, and there are more favorable reports for them. Some others have been less studied and need to be investigated in future studies, like different physical therapy modalities.

Conclusion: Recommendations are based on low- to moderate-quality evidence or consensus in the management approach studies for disc-related LBP. Therefore, the authors recommend intensifying research efforts concerning all aspects of the non-surgical management of LBP.

Effectiveness of Physiotherapy Intervention for Elderly People with Diabetic Neuropathy: A Review Study

2024-07-01T16:25:19+00:00

Introduction: Diabetic neuropathy (DN) is one of the most complex and progressive disorders, characterized by symmetrical distal degeneration of peripheral nerves, resulting in features of pain and sensory loss. This study aimed to find out the effects of physiotherapy intervention on physical function, balance, and postural control of persons with DN.

Materials and Methods: A computerized electronic search was performed using PEDro, Pubmed, CINAHL, and EMBASE with keywords including physiotherapy intervention, physical exercise, rehabilitation techniques, balance training, diabetic neuropathy, and diabetic peripheral neuropathy. The inclusion criteria consisted of studies that were randomized clinical trials, crossover trials, or controlled trials published in the English language from 2015 to 2021, identifying DN as the primary concern, and physiotherapy intervention as one of the treatment options.

Results: The primary search of the database turned up an entire set of 58 studies, among which 11 studies were selected as potentially meeting the inclusion criteria. Ultimately, four studies were retained for the final results of the review. The evaluations provided evidence to suggest that physiotherapy has positive effects on subjects with diabetic peripheral neuropathy.

Conclusion: After reviewing, it has been revealed that balance and strength training are applicable for improving balance, gait, and physical function in DN patients.

Selective Impairment of Verb Tense in MazandaraniSpeaking Agrammatic Patients

2024-07-01T16:25:04+00:00

Introduction: Among many grammatical problems affecting agrammatic patients, those of inflectional morphology, specifically tense, stand at the forefront. This study aimed to analyze tense properties in Mazandarani-speaking Broca patients to see which aspects of this inflectional system were more negatively affected.

Materials and Methods: Utilizing inclusion/exclusion criteria, we chose 10 patients (mean age 47 years) in this descriptive-analytical research. To select our participants, some criteria including the results of the Persian aphasia test, monolingualism, and magnetic resonance imaging reports were considered which corroborated the involvement of the anterior frontal lobe, inferior anterior parietal lobe, Perisylvian, and Broca’s areas as well as inferior frontal gyrus. To monitor our patients’ performance in three separate tenses of present (progressive), future, and past (simple past, past perfect, and past continuous), we administered written sentence completion and sentence-to-picture matching tests. To investigate whether our patients’ performance in diverse verb tenses was significantly different, we utilized Wilcoxon statistics to analyze our data.

Results: The results demonstrated a significant difference between the performance of the patients in past progressive tense compared to other tenses (P=0.02). Furthermore, a significant difference was observed between the mean responses to past tenses and present-future tenses.

Conclusion: Mazandarani-speaking agrammatic demonstrated selective poor performance in the past tense inflection. Regarding the crucial role of tense properties in verbal communication, specifically past tense, to talk about past events and memories, more attention is needed by clinicians and speech therapists to reinforce tense properties enhancing agrammatic communication capabilities.

The Effects of Physiotherapy Management in Hospitalized Patients with Coronavirus Disease Based on Gender Differences

2024-07-01T16:24:52+00:00

Introduction: COVID-19 which is an infectious disease caused by the SARS-CoV-2 virus hurts patients’ respiratory health by necessitating oxygen therapy. The affected patients with COVID-19 experience anxiety and stress with quality of life (QoL) impacted due to frequent medication, hospitalizations, fear of dying, and isolation. In individuals with respiratory problems, physiotherapy is useful in improving oxygenation, stress reduction, and QoL. Therefore, our goal was to assess how physiotherapy management affected the oxygenation rates and QoL of hospitalized COVID-19 patients.

Materials and Methods: The study included 60 hospitalized cases of COVID-19 pneumonia (25–65 years) admitted to the RCU/Al-Hussein teaching hospital. The oxygenation rate was recorded by hospital monitoring. A physiotherapy management prepared according to the pulmonary rehabilitation recommendations for COVID-19 patients. QoL was assessed by the Arabian version of the short-form health survey questionnaire (SF-36) at baseline, at discharge, and 1 month after discharge.

Results: The mean baseline oxygenation percent was 86.10±12.93. The baseline QoL score was 29.14±18.52. A significant increase (P<0.0001) in oxygenation (by 10.22%) was observed at discharge as compared to the baseline values. The QoL was significantly higher (P<0.0001) at 1-month post-discharge as compared to the baseline and the values at discharge (by 157.76%). Similar effects were observed in males and females.

Conclusion: A short-term course of physiotherapy management was effective in increasing the oxygenation rates and QoL in hospitalized male and female COVID-19 patients. A combination of breathing exercises, early mobilization, and positioning can act as an adjuvant in the clinical management of COVID-19 patients.

The Effects of Deep Neck Muscle Exercises on Chronic Non-Specific Neck Pain

2024-07-01T16:24:37+00:00

Introduction: The study aimed to investigate the effects of deep neck flexor (DNF) and deep neck extensor (DNE) muscle exercises on pain, passive range of motion (PROM), craniovertebral angle (CVA), neck flexor endurance (NFE), neck extensor endurance (NEE), and the number of weekly painkiller usage (NWPKU) in chronic non-specific neck pain (CNNP) patients.

Materials and Methods: A total of 27 CNNP patients, incuding intervention group (n=15) and control group (n=12), were recruited for this study. Patients in the intervention group participated in 6 weeks of DNF and DNE exercises plus traditional physiotherapy. After 10 sessions (3 weeks), the exercise protocol was followed for 3 weeks of the home-based exercise form. Control group patients received traditional physiotherapy alone. The numeric pain rating scale (NPRS), PROM, CVA, NFE, NEE, and NWPKU were examined and compared between groups, at the baseline and after six weeks.

Results: Numeric pain rating scale, PROM, CVA, NFE, NEE, and NWPKU improved significantly in both groups after treatment (P<0.001). The NPRS, passive flexion, passive extension, passive right-side bending, passive left rotation, CVA, NFE, NEE, and NWPKU differences were significant (P<0.05).

Conclusion: The study supports the positive effects of combination therapy (DNF and DNE exercises plus traditional physiotherapy) on pain, passive neck range of motion, neck lordosis posture, and neck muscle endurance in CNNP patients.

The Effect of Islamic Praying on Heart Rate Variation in Adult Muslims

2024-07-01T16:24:23+00:00

Introduction: The flexibility of the heart is important for cardiovascular health. The heart rate variation (HRV) is a metric of heart flexibility. Muslims perform praying (Namaz) which has some significant effects on general health regularity. The study aimed to assess the impact of real Namaz on HRV.

Materials and Methods: Eighty-two participants who performed Namaz daily were categorized into three groups, including more minor, more than, and equal to the normal cortisol level range based on salivary cortisol. The electrocardiography was recorded before, during (divided into standing, bowing, prostration, and sitting positions), and after a four-cycle Namaz around noon. The linear and non-linear features of HRV were extracted.

Results: The two-way analysis of variance showed that the standard deviation (SD)1 and SD2 of the Poincare plots of all groups increased after Namaz (P<0.0001). During Namaz, the indexes of sympathetic tone decreased in the prostration and bowing compared to the sitting and standing positions (P<0.00001). The SD of the mean of the R peaks interval, SD1 , and SD2 of the Poincare plot also increased in those comparisons (P<0.00001). In addition, the spectral entropy was decreased in the bowing and prostration compared with standing and sitting positions (P<0.001).

Conclusion: Namaz significantly increased the performance of the cardiovascular system and decreased the effect of daily stress on it.

Design, Implementation, and Evaluation of a Logbook for Clinical Education of Undergraduate Physiotherapy Students

2024-07-01T16:24:11+00:00

Introduction: Clinical performance without documentation, assessment, and feedback may lead to an inefficient internship in the field. Logbooks are recommended to assess physiotherapy (PT) students’ clinical practice in the curriculum, therefore, this study aims to design, implement, and evaluate a logbook for undergraduate PT students.

Materials and Methods: The present study includes three phases. In the first phase, a logbook was designed based on the existing evidence, undergraduate PT program curriculum, and opinions of clinical instructors of the relevant internships. After that, it was adjusted based on the topics of clinical rotations. In the implementation phase, students completed these logbooks during neurology, musculoskeletal inpatient, outpatient, and cardiovascular inpatient rotations. In the third phase, a 29-item questionnaire was used to assess the students’ and instructors’ perspectives on the logbook.

Results: The designed logbook for undergraduate PT students consisted of two major sections, assessment of students’ clinical competencies and documentation of clinical experience. Sixtynine students and 12 clinical instructors completed the questionnaires. Approximately 49% of the students and 87% of the instructors felt that the logbook’s quality was satisfactory. Nearly 53% of the students and over 90% of the instructors consider the use of the logbook and its content essential.

Conclusion: A logbook was developed as a workplace-based assessment (WBA) method. It was designed to cover different internships, including PT in musculoskeletal, cardiovascular, and neurological conditions in outpatient or inpatient settings. Both students and instructors agreed on using the designed logbook to assess the student’s clinical performance.

Executive Functions and Stuttering Severity in Persian Adults

2024-07-01T16:23:58+00:00

Introduction: Fluent speech requires executive functions to identify, inhibit, and modify speech interruptions to continuously regulate the speech process. The current study aims to examine the executive functions in adults who stutter (AWS) and adults who do not stutter (AWNS). We also examined the relationship between executive functions and stuttering severity.

Materials and Methods: This research is a cross-sectional descriptive-analytic study. The participants included 32 AWS (Mean±SD of age=28±6.79) divided into three groups of mild, moderate, and severe severity and 32 AWNS (Mean±SD of age=28.57±6.53). Selected tests from the Delis-Kaplan executive function system (D-KEFS) were used to assess executive function domains.

Results: The results of this study showed that AWS performed significantly lower than AWNS in working memory (P=0.009), problem-solving and planning (P<0.001), verbal cognitive flexibility (shifting) (P<0.001), and verbal inhibitory control (P<0.001). The results also showed no difference between AWS and AWNS in non-verbal inhibition, shifting, and reasoning. Furthermore, a significant relationship was observed between stuttering severity and executive function domains.

Conclusion: This study showed that executive function skills are affected in AWS and should be considered in the rehabilitation programs of AWS.

Criterion Validity of Infant-Toddler Meaningful Auditory Integration Scale for Persian Children with Cochlear Implantation

2024-07-01T16:23:44+00:00

Introduction: The infant-toddler meaningful auditory integration scale (IT-MAIS) can evaluate toddlers and infants’ early auditory development in aspects of detection, discrimination, and identification of sounds. The present study aims to evaluate the reliability and criterion validity of the Persian version of the IT-MAIS (IT-MAIS-P) for children with hearing loss (HL).

Materials and Methods: In this study, due to the limitations of COVID-19 and the lack of access to samples, 23 available children with HL were sampled. The cause of participants› HL was 43.5% congenital, 30.4% acquired, and 26.1% unknown. The Mean±SD of the age of these children was 21.6±6.3 months. To evaluate the predictive validity and concurrent validity, the speech intelligibility rating (SIR) and categories of auditory performance (CAP) were used, respectively. Also, to assess the inter-rater reliability, both parents of each child completed the IT-MAIS-P.

Results: A significant correlation (concurrent validity) was observed between the IT-MAIS-P and the CAP scores (r=0.87, P<0.001). Predictive validity was not confirmed by comparing it with the SIR (P>0.05). Also, the inter-rater reliability (kappa=0.44, P<0.001) of the IT-MAIS-P was confirmed.

Conclusion: The IT-MAIS-P is a valid tool to investigate the progress of auditory skills in infants, although the predictive validity was not confirmed.

Clinical Features of Surgery Candidates for Different Types of Extraocular Muscle Palsy

2024-07-01T16:23:30+00:00

Introduction: Clinical manifestations of cranial nerve palsies are of great importance, and surgeons should consider them before planning surgical protocol.

Materials and Methods: This retrospective study was conducted on preoperative hospital records of 598 Iranian patients with different types of extraocular muscle palsy, including third (90 patients), fourth (501 patients), and fifth (7 patients) nerve palsy at Farabi Hospital, Tehran Province, Iran.

Results: In terms of fourth nerve palsy, the mean spherical equivalent (SE) in the right and left eye was 0.23±1.51 and 0.19±1.45 diopter, respectively. Also, the mean angle of vertical deviation was 15.54±8.85 Δ at near and 15.66±8.93 Δ at far. In patients with third nerve palsy, the mean SE in the right and left eye was -0.02±2.08 and 0.08±1.95 diopter, respectively. Also, the mean angle of vertical deviation was 17.8±17.4 Δ at near and 17.8±17.5 Δ at far. In terms of six nerve palsy, the mean SE in the right and left eye was -1.27±3.37 and -1.08±2.52 diopter, respectively. Also, the mean angle of esotropia was 32.4±7.7 Δ at near and 33±6.7 Δ at far. The frequency of amblyopia in patients with third, fourth, and sixth nerve palsies was 21 patients (23.3%), 70(14%), and 4(57.1%), respectively.

Conclusion: The clinical characteristics of patients with different types of EOM palsy are remarkably different, which can be attributed to the different properties of these kinds of deviations.

Factors Influencing Discontinuation of Exercise Therapy During Hemodialysis

2024-07-01T16:23:16+00:00

Introduction: Various exercise therapy methods have been devised for dialysis patients. Nonetheless, even the best exercise regimen is ineffective if not sustained. This study aims to determine the dropout rate and factors influencing exercise therapy discontinuation during dialysis.

Materials and Methods: This observational, retrospective, and descriptive study included 31 people who underwent exercise therapy during hemodialysis sessions between April 2015 and March 2018 at a hospital. The mean age of the participants was 59.29±11.12 years (range 36– 78 years), and the male/female ratio was 24/7. The participants were divided into two groups, the continuation group (15 patients who continued exercise) and the discontinuation group (16 patients who discontinued exercise). Data on physical function history (knee extension muscle strength, one-leg standing time (OLS), and 6-minute walking distance (6 MD)) were collected from medical records. All participants were interviewed using a questionnaire on factors involved in exercise discontinuation from April 2018 to March 2022.

Results: About half of the participants dropped out (51.6%). In particular, the results suggested that body pain was strongly associated with exercise discontinuation. In addition, 8 participants in the discontinuation group died during follow-up after exercise discontinuation (50%).

Conclusion: The study results suggest that it is essential to increase self-efficacy and satisfaction by devising exercise content that meets the individual’s wishes to prevent dropouts during dialysis. In addition, measures against body pain are crucial to continue exercising. The relationship between exercise discontinuation during hemodialysis and mortality should be further examined.

The Effect of Kinesio Taping on Lumbar Kinematic After Static Lumbar Flexion in Healthy Subjects

2024-07-01T16:23:03+00:00

Introduction: The application of Kinesio taping (KT) is a rehabilitation technique used to provide muscle and joint support and stability, without limiting the range of motion (ROM). No study evaluated the effects of KT on lumbar flexion relaxation phenomenon and kinematic details after static flexion. This study aims to find out the results of KT on erector spinae (ES) muscle activity, flexion relaxation pattern, and trunk, lumbar, and hip range of motion in healthy subjects during static flexion

Materials and Methods: This study used a two-factor within-group design. Twenty-two healthy female students participated in this study. We used surface electromyography (EMG) to assess ES muscle activity and measured kinematic information with data from the camera. Variables related to muscle activity and angles in forward bending movement before and after creep were investigated. The test was performed in two situations with and without the use of KT.

Results: KT reduced the time of muscle activity during bending. Also, KT increased trunk, and hip angles at the end of forward flexion. In the lumbar extension phase, the ES muscles were activated later

Conclusion: KT can prevent the increase of lumbar spine flexion angle due to the creep effect. It can be used to protect the strained viscoelastic structures and increase the involvement of cutaneous receptors. KT can act as a protector in the dynamic stabilization system of lumbar joints in flexion positions in healthy people.

Assessment of the Quality of Life and Relationship of Mental Status Among Parents with Cerebral Palsy Children in a Single Centre Study

2024-07-01T16:22:50+00:00

Introduction: Children with cerebral palsy (CP) in Bangladesh suffer immensely, with no means or hope for a decent life and a public system lacking basic facilities.This study aims to analyze the quality of life (QoL) and depression status of parents among children with CP, as well as the relationship between these factors and their demographic profile.

Materials and Methods: This is a descriptive cross-sectional study in which data were collected from the Pediatric Department of Centre for the Rehabilitation of the Paralysed (CRP) in Savar. The participants included 150 children with CP between January 2018 and December 2020.

Results: The mean age of the mothers (29.86±6.14) was between 25 and 29 years (32.7%). The most common type of CP was spastic CP among 100 mothers (66.7%). A significant relationship was observed between the mother’s age during marriage and World Health Organization quality of life (WHOQoL-BREF), physical health (P<0.01), psychological health (P<0.01), and the age group of 31-35 years had the lowest scores (Mean±SD 62.00±5.16, 51±0.683) in both domains. A strong correlation (P<0.001) was observed between QoL, physical health (r=0.319), psychological (r=0.365), social (r=0.390) and environmental (r=0.388). From the box plot, QoL showed that spastic CP posed good QoL for mild depression while all other types had neither poor nor good QoL.

Conclusion: A hidden issue in every parent is that CP children are the misfortune of their fate that increases their level of depression and consequently decreases their QoL.

Low-Energy Versus Middle-Energy Extracorporeal Shockwave Therapy for Treating Pes Anserine Bursitis

2024-07-01T16:22:36+00:00

Introduction: Pes anserine bursitis (PAB) is a painful status inside the knee that may interfere with functional activities. Extracorporeal shockwave therapy (ESWƬ) may treat this disorder.

Objective: Comparing the effects of low- versus middle-energy ESWƬ on pain and functional activity in patients with sub-acute PAB.

Materials and Methods The study was a single-blind randomized trial. Twenty-eight patients with sub-acute PAB were randomly divided into two groups and received either low or middleenergy ESWƬ for three weeks. The numeric pain rating scale (NPRS), short-form McGill pain questionnaire (SF-MPQ), timed up and go (TUG) test, and Western Ontario and McMaster universities index (WOMAC) were evaluated before and 2 and 3 weeks after the intervention.

Results: A significant improvement was observed for low-energy ESWT in terms of NPRS (P=0.001), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. Also, a significant improvement was observed following middle-energy ESWT application on NPRS (P=0.003), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. A similar trend was observed between study time points and for all variables in each group. The only exception was the TUG, which showed no improvement between 2 and 3 weeks after the intervention for each study group. A significant improvement was observed in the NPRS between the two groups after 2 weeks (P=0.001) and 3 weeks (P=0.006), both favoring the middle-energy ESWT application.

Conclusion: Low- and middle-energy ESWT can effectively improve pain, functional activity, and mobility in patients with PAB.

A Multidisciplinary Extended Approach to Physiotherapy Rehabilitation in Guillain-Barre Syndrome as Sequelae of COVID-19: A Single Case Study

2024-07-01T16:22:23+00:00

Introduction: Coronaviruses can cause widespread systemic infections, the most common of which are respiratory complications, which are close to the symptoms of serious acute respiratory syndrome coronavirus (SARS-CoV).

Case Description: We report a case of a 16-year-old boy who developed weakness in bilateral lower limbs, difficulty in coughing, and generalized weakness for 2 days. He was diagnosed with post-COVID Guillain-Barre syndrome (GBS). Cerebrospinal fluid (CSF) analysis manifested a CSF protein of 117 mg/dL, a white blood cell count of 6-7/mm3 , and a glucose of too low to comment. Magnetic resonance investigation of the brain revealed mucosal thickening in the bilateral maxillary, ethmoid, and left frontal sinuses. Nerve conduction studies concluded evidence of sensory-motor polyneuropathy. Physiotherapy intervention included patient education, breathing retraining, airway clearance techniques, positioning, a combination of chest proprioceptive neuromuscular facilitation (PNF) techniques, a walking program with supplemented oxygen, and psychological support.

Results: Outcome measures have shown enhancement in functional independence and performance of activities of daily living.

Conclusion: The evidence from this study suggests that pulmonary rehabilitation plays a pivotal role in managing a patient who is diagnosed with post-COVID GBS, which includes patient education, breathing retraining, airway clearing techniques, a combination of chest PNF techniques, positioning, a walking program with augmented oxygen, and psychological support.