- LETTER TO THE EDITOR
- SYSTEMATIC REVIEW
- RESEARCH REPORTS
- SPECIAL REPORT
- The articles for the PJR Issue 2019 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.
OCCUPATIONAL THERAPY AN EMERGING NEED FOR HEALTH AND WELLBEING
Globally the need of rehabilitation is higher in low and middle income countries as compare to developed countries, to promote independence in function, participation in learning, productivity in terms of earning and perform roles significantly in the life. This rise in demand of rehabilitation has promoted the need of rehab professionals for health and wellbeing of an individual.
NON INVASIVE BRAIN STIMULATION TECHNIQUE – AN AREA NEEDS TO BE EXPLORED
Aspiration to enhance human capabilities by increasing cognitive functions and physical performance is a novel approach; however, mechanism to increase human performance to the highest level has been the topic of interest for the researchers since centuries. The activity of human brain can be altered through electrical stimulation that is purely noninvasive. Recently, Studies conducted by rehablitationists have emphasized the use of non-invasive electrical stimulation; one of the non-invasive brain stimulation (NIBS) techniques that induces excitability in human motor cortex is transcranial direct current stimulation (tDCS) that work by process of neuro modulation1. The advantages of NIBS are significant, as it has very rare or no adverse effects and does not require any kind of surgical procedure2. On the other hand, there are significant limitations in administering pharmacological treatments, causing non-specific effect and moderate to severe hostile effects3. While other contemporary physical and behavioral therapies are much safer and specific, depending on the available resources for therapist and training protocol and patient’s cooperation. There is therefore an evident unmet clinical need for the development of new therapeutic approaches in physical and rehabilitation medicine. NIBS is a new approach with positive clinical results explored in the last decade, these methods of brain stimulation are painless and can easily excite and modulate the brain functions. At present, various noninvasive electrical brain stimulation methods have been introduced by commercial providers and now been used by elite sports coaches, that are helping in improving the mental abilities, cognitive functions, balance and also assisting in dealing with the stress4. In general, neuromodulation of the human brain can be achieved noninvasively by delivering magnetic, electric and auditory and visual bursts of pulses5 to predefined cortical regions. So far, there is little empirical evidence for the efficacy of brain-stimulation techniques on enhancement of sports-specific performance6. Hence, as per my understanding and knowledge the research work conducted on such approaches is scarce in Pakistan. Dear Editor, by the virtue of this prestigious journal I would like to draw your kind attention towards this unexplored area of research work, it seems plausible that these emerging techniques will be a future, legitimate way to enhance physical and mental performance.
EFFECTS OF PHYSIOTHERAPY INTERVENTIONS ON FALL, POSTURE AND QUALITY OF LIFE IN PARKINSON DISEASE
BACKGROUND AND AIMS
Parkinson disease is the 2nd most common neurological disorder worldwide that is mainly associated with motor system. The role of non-pharmacological treatment in the management of fall, posture and improving quality of life is yet unclear therefore this review was conducted to evaluate the effects of physiotherapy interventions on fall, posture and quality of life in PD patients.
DATABASES AND ELIGIBILITY CRITERIA
A literature search was conducted through Google Scholar, PEDro, Cochrane Library, Med-line, CINAHL, Web of Science and PubMed included 18 randomized controlled trials evaluating physiotherapy interventions effects on fall, posture or QOL in PD patients that published in the year 2010 to onwards 2019 were included.
Methodological quality and risk of bias was assessed using the Cochrane tool for assessing risk of bias. The findings revealed that PT treatments like resistance training, balance exercises, exergaming and low-intensity trunk exercises are effectual in enhancing QOL and postural imbalance. However resistance strength training, fall education and gait training more effectively reduces fall.
Physiotherapy interventions play an essential role in the treatment of fall, postural imbalance and QOL. These interventions should be integrated in the treatment plan so that PD patients can achieve greater independence in their lives.
EFFECT OF HYDROTHERAPY ON SPASTICITY AND GROSS MOTOR FUNCTIONS AMONG SPASTIC CEREBRAL PALSY CHILDREN
To determine the effects of hydrotherapy therapy on spastic cerebral palsy children using Modified ashworths scale and Gross motor functional classification scale after 32 weeks of training protocol.
Quasi experimental study
Liaquat National Hospital
Spastic (diplegic, hemiplegic and quadriplegic) cerebral palsy children
58 Spastic Cerebral Palsywere assessed on the basis of modified Ashworth scale and gross motor function measure for spasticity and change in gross motor function respectively. Assessment was done, before and at the end of 10th week. Each therapy session was of 40-45 minutes thrice a week in a pool with the temperature maintained at 32°C-34°C and at the end cool down activities were performed.
Results indicated marked improvement in Muscle tone and Gross Motor Functioning of the enrolled children with p=0.001.
It was concluded that pool therapy is effective in reducing spasticity and improving gross motor functions among CP.
COMPARING THE EFFICACY OF UPPER TRAPEZIUS KINESIOTAPING AND STRETCHING EXERCISES IN PATIENTS WITH MECHANICAL NECK ACHE
BACKGROUND AND AIM
Globally, around one third of population is suffering from persistent neck pain and it is considered as 4th important source of disability in the population. Several treatment protocols are available now a day to facilitate patient recovery. Therefore, the aim of this study is to identify the effects of kinesiotaping in improving neck pain, upper trapezius muscle strength and functional disability.
Randomized controlled trial
68 participants were recruited for the study.
All participants of age 18-40 years were assessed using assessment Performa. Pain intensity, upper trapezius muscle strength and Neck disability index were measured at baseline and after treatment sessions. Group A comprised of 34 participant, received Kinesiotaping and conventional physical therapy treatment whereas, equal number of participants were recruited in Group B that received upper trapezius stretching and conventional physical therapy.
The study revealed that both interventions (Kinesiotaping and stretching) were effective i.e., <0.05 in improving pain intensity, muscle strength and functional disability in patients with mechanical neck ache but significant improvement were recorded in group treated with kinesiotaping.
The study concluded that both interventions are effective in improving pain intensity, muscle strength and neck disability index but kinesiotaping is more beneficial than stretching among patient with mechanical neck ache.
EFFICACY OF TENS WITH CONVENTIONAL OCCUPATIONAL THERAPY IN IMPROVING HAND FUNCTION OF STROKE SURVIVORS
BACKGROUND AND AIM
Stroke is currently the second leading cause of death and third main cause of disability throughout the world. Around 75% of stroke survivors suffered from upper limb dysfunction with limited functional activities whereas distal parts of upper extremity such as hand and forearm are mostly affected by stroke. Therefore, this study aims to determine the benefits of TENS along with conventional Occupational therapy in the rehabilitation of stroke patients to ascertain the optimal recovery of hand function.
A Single-blind Randomized Controlled Trial was conducted on 76 individuals with acute phase or one-year history post-stroke. Group-A (n=38) received Low Frequency Transcutaneous Electrical Nerve Stimulation on elbow and wrist extensors (3 Hz, 400 μs)along with conventional Occupational therapywhile Group-B (n=38) received conventional Occupational therapy only. Both the groups received intervention for 5 days/week of duration 45 minutes till 3 weeks.
Group-A showed significant improvement in means scores of FMA-UE and ARAT (p<0.05) in comparison to Group-B which showed moderate improvements in sensorimotor and activity capacity of hand function.
Conventional therapy along with TENS significantly improved the hand function in acute stroke patients as compared to the conventional therapy.
VISUAL SUPPORT REDUCES ANXIETY IN AUTISM SPECTRUM DISORDER AND ENHANCE THEIR VISUAL PERCEPTUAL SKILLS
Children with Autism Spectrum Disorder (ASD) have difficulties with sensory processing that result in anxiety in certain situations. Aim of this study is to determine the efficacy of visual supports in reduction of anxiety levels and tolerance of transitions or switch over in children with ASD.
Randomized controlled trial
With a sample size of 57, comparison was made between two groups i.e.; the experimental and the control group to see the efficacy of the visual inputs in reducing anxiety in children with ASD of age bracket 8-12 years old. Experimental group was given visual aids with occupational therapy sessions, while control group was only given conventional Occupational Therapy sessions. Pre and post analysis of visual perceptual ages and the anxiety levels of children were compared by anxiety scale for children-spectrum disorder and motor-free visual perception test.
Significant increase in the visual perceptual ages with reduction in anxiety level was observed in experimental; no significant difference was found in control group.
Reduction in the anxiety levels was achieved after 4 weeks of intervention with improvement in the visual perceptual ages in the experimental group.
ASSOCIATION OF DEPRESSION, ANXIETY AND STRESS WITH QUALITY OF SLEEP AMONG DPT STUDENTS OF ZCRS
AIMS AND OBJECTIVES
Sleep deprivation is a major contributor of health and mental problems that may cause serious difficulties in accomplishing ADL’s among students although severe health and mental conditions have direct impact on the quality and quantity of sleep too. Thus, this study aims to determine the quality of sleep and its association between anxiety, depression, and stress to improve health related quality of life (HRQOL) among undergraduate DPT students of ZCRS.
A cross-sectional survey
325 students were selected through convenience sampling technique from pre-clinical (1st, 2nd) and clinical (3rd, 4th, 5th) years of DPT program.
Data was collected on by providing Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scale-21 to both students of pre-clinical and clinical years at beginning, middle and end of semester to determine the association of related outcome measures.
Strong association was found between sleep deprived students with depression, anxiety, and stress on chi-square test of association (p<0.05).
It was concluded that high prevalence of anxiety followed by depression and stress with the quality of sleep along with the amount of sleep in university students during all three phases of their academic semester. Although studies proposed genetic co-relation with anxiety, depression and stress as well as with the quality of sleep.
- Beenish Zafar
- Assistant Professor
- Ziauddin College Rehabilitation Sciences
- Ziauddin University
- [email protected]
- Farzana Amir
- Head of Department
- Preventive Cardiology & Cardiac
- Chair Institutional Review Committee
- TABBA Heart Institute
- [email protected]
- Syed Wasif Ali
- Associate Professor
- Jinnah College of Rehabilitation Sciences
- [email protected]
EFFECTIVENESS OF LUMBAR STABILIZATION EXERCISES IN NON-SPECIFIC LOW BACK PAIN AMONG OCCUPATIONAL THERAPISTS
BACKGROUND AND AIMS
Low Back Pain (LBP) is considered as the second leading source of musculoskeletal disorders, affecting 85% individuals worldwide at some point in their life time. Numerous studies estimated Occupational Therapists have predominant risk of developing LBP due to nature of their daily activities therefore the aim of this study is to evaluate the effectiveness of lumbar stabilizing exercises among Occupational Therapists with non-specific LBP.
A single blind, RCT was conducted at Dr. Ziauddin Hospital included 30 Occupational Therapists divided in to Group A and B that received lumbar stabilization and general extension exercises respectively. Both the groups received 4 weeks of intervention on 6 days/week. Data was collected Pre and Post the treatment on Numeric Rating Scale and Oswestry LBP Disability Questionnaire.
Both the groups showed significant results (p<0.05), however Group A showed marked reduction in pain and disability in comparison to Group B that showed moderate decrease in both outcome measures.
Lumbar stabilization exercises are more effective to reduce LBP as compared to general extension exercises. Multi-center trials are recommended in the management of LBP in healthcare professionals to prevent musculoskeletal disorders.
EFFICACY OF LOW ENERGY NEUROFEEDBACK SYSTEM IN REHABILITATION OF MENTAL HEALTH DISORDERS
The Low Energy Neuro feedback System (LENS) is one of the growing approaches used to bring Quality of life (QOL) to the patients suffering from mental health issues and Nervous system disorders by elevating the symptoms. It is a computer- based software program that is connected to EEG box which measure brain waves. This approach is different from Neuro feedback technique as it uses very low electromagnetic strength. It brings in noticeable improvement after few second of treatment session which does not require conscious awareness or voluntary participation from the client. It was first developed in the early 1900s by Dr Len Ochs to treat uncontrolled epilepsy, followed by many researches that signify its beneficence for treating many neurological and mental health disorders. This technique does not cure the disorder though it does elevate symptoms that improve the QOL. Although LENS is being exercise around the world, it is still unidentified by many professionals in Pakistan. Use of LENS adjacent to other therapies will bring revolution in Pakistan mental health rehabilitation. More research on LENS is suggested.