Journal Riphah College of Rehabilitation Sciences

Characteristics 0f Tinnitus and its Association with Clinico-demograhic Factors & Mental Health.

Maria Murtaza — 2024-03-31

Objectives: To determine the characteristics of tinnitus and its association with clinical and demographic variables including psychological health.

Methodology: This cross-sectional study recruited N=80 tinnitus cases from ENT outpatients of District Head Quarter Hospital Chakwal from over a period of 6 months from 1st Jan 2019 to 31st June, 2019, using convenience sampling. Sample included both genders, aged 18-75 years with tinnitus for at least three months. Tinnitus Handicap Inventory (THI) & Depression Anxiety and Stress Scale 21 (DASS-21) were utilized for data collection & analysis done using SPSS-version 20. Anova statistics & Pearsons correlation was determined for THI and DASS-21. Chi-square was used to see any association with clinic-demographic variables. P<0.05 was considered significant.

Results: Study revealed 30(37.5%) cases with mild, 20(25%) each with moderate and severe while least 4(5%) catastrophic tinnitus. Tinnitus severity was significant associated with gender (p=0.005), age (p=0.035), educational level (p=0.049), occupation (p=0.002), duration of tinnitus (p=0.038), site of tinnitus (P<0.001) and type of tinnitus sound (P=0.003). Duration of tinnitus was associated with anxiety (p=0.024), site of tinnitus was associated with THI (p=0.016), anxiety (p=0.021), stress (p<0.001) and depression (p=0.02) and total DASS-21 (p=0.005). A significant positive correlation was present between tinnitus handicap, Anxiety, stress, depression and DASS-21 total score (P<0.001).

Conclusion: Mild tinnitus was most prevalent (37.5%) with Tinnitus severity having significant association with gender, age, educational level, occupation, duration of tinnitus, site of tinnitus, and type of tinnitus sound. Duration of tinnitus was also associated with anxiety while site of tinnitus has association with THI, anxiety, stress, depression and total DASS-21. Significant positive correlation is present between THI and Anxiety, stress, depression and DASS-21 total score.

Effect of Virtual Reality Game Based training in Gait Improvement of Post Stroke Patients: A Quasi-experimental Study

Shakir Ullah — 2024-03-31

Objective

The objective of this study was to determine the effectiveness of task specific virtual reality training for better ambulation in post stokes patients.

Methodology

This study was a quasi-experimental study (single group) with non-probability convenient sampling. Baseline assessment was taken at start of study and final assessment was done after 8 weeks. SPSS version 23 was used to analyze and record the data. Descriptive statistics was used to calculate mean and SD for all continuous data and percentages were calculated for all categorical data. Paired T test was used to compare mean change in continuous data before and after intervention.

Results

Although there was some improvement in pre and post scoring on outcome measurement scales applied in this study, still there is no significant difference between pre and post walking speed (P Value 0.702), TUG test (P Value 0.146), MAS scale (P Value 0.227), forward stepping test P Value (0.089) and functional reach test P Value (0.415).

Conclusion.

This study concluded that, VR based task specific training is an effective treatment for post stroke patients regarding their gait rehabilitation, as for scoring is concerned on different outcome measures but overall results are not statistically significant.

Key Words

Cerebrovascular Accident, Gait, Gait Disorders, Stroke, Virtual reality

Impact of Bilingualism on Speech Sound Disorder/ Articulatory and Phonological Disorders

Sadaf Noveen — 2024-03-31

Objectives: To explore the impact of bilingualism on speech sound disorders in Pakistani 4-8 years old children.

Methodology: This cross sectional exploratory study using convenient sampling recruited N=140 children suspected or having speech sound disorders. Sample included 4-8 years old children of both genders speaking Urdu and their native language from the speech clinics of four provinces of Pakistan from 1st March to 31st October 2016. Basic demographic sheet and Test for Assessment of articulation and Phonology in Urdu was used for data collection. Analysis done using SPSS Version-21. Chi-square & Pearson correlation was utilized and p<0.05 was considered significant.

Results: The number of errors and mother tongue did not show correlation (r=.006, p=.499), while error type and mother tongue revealed weak negative correlation (r=-.091), concluding their non-relation with language. However, there was predominance of substitution 93(66.4%) followed by omission 27(19.3%) and distortion 20(14.3%) errors, with substitution being commonest in Pushto, omission in Urdu and distortion in Punjabi speaking. Also phonological process of liquid gliding was absent ( /r/ is substituted with /l/) in Urdu language and children were intelligible despite articulatory or phonological errors and intelligibility continues developing after 4 years of age.

Conclusion: The speech sound errors are independent of languages learned by the child because the phonetic repertoire and articulatory movements for a sound in every language is similar. A child growing up in a native language environment will make similar articulatory errors in Urdu and the native language.

Frequency of Low Back Pain and its Effect on Function and HealthRelated Quality of Life across Three Levels of Lower Limb Amputation: A Cross-Sectional Study

Muhammad Usman — 2024-03-31

Background: An amputation is a dramatic event that brings marked changes in an individual life which may affect the person physically and psychologically.

Objective: To determine the frequency of non-specific low back pain and its effect on function and health-related quality of life across three levels of lower limb amputation.

Methods: A cross-sectional study was conducted at the Pakistan Institute of Prosthetic and Orthotics Peshawar (PIPOS) from May 2020 to Sep 2020. The inclusion criteria were: both males and females ages 18-65 years, patients with unilateral transfemoral, knee disarticulation, and transtibial amputation. The data were collected via a self-administered questionnaire. The outcomes were measured by the Roland Morris disability questionnaire (RMDQ), The short form 36 health survey (SF-36), and questions about the prevalence of LBP. The data was analyzed by SPSS v.25.

Results: A total of 264 amputees with a frequency of male 219 (83%) and female 45(17%) participated in this study. There was a significant association between pre and post-amputation back pain (P< 0.05) while no significant association was found between LBP and across the three levels of amputation (P> 0.05). There was no statistical difference between disability and level of amputation (P> 0.05). A statistical difference was found between low back pain and all domains of quality of life except mental and physical health with (P< 0.05) while no statistical difference was found in the quality of life and across the three levels of amputation (P> 0.05).

Conclusion: This study found that LBP was prevalent after amputation. There was a significant association between low back pain before and after amputation while no significant association was found in low back pain across the three levels of amputation. The effect of low back pain on disability was found statistically significant and the effect of low back pain on quality of life was significant in some domains like Physical function, and social function.

Effects of Perfetti's Method on Cognition, Dexterity and Sensory Motor Function of the Upper Extremity in Stroke Patients: A Randomized Controlled Tria

Syed Muhammad Mateen — 2024-03-31

Background: A stroke is the sudden loss of neural function caused by an interruption of blood flow to the brain. It causes symptoms such as paresis, hypoesthesia, cognitive impairment, spasticity.

Objective(s): To compare the effects of Perfetti’s Method versus routine physical therapy on cognition, dexterity, and sensory motor function of the upper extremity in stroke patients.

Methodology: In this study, 74 stroke participants were enrolled. Randomised into two groups, with 37 patients in each group. Group A was treated with routine physical therapy, and Group B was treated with Perfetti’s Method and routine physical therapy. The measurements of both groups were recorded at the beginning of the study and after the 12th post-treatment week. Sensory motor function was measured with the Fugal-Meyer Assessment Upper Extremity (FMA-UE), dexterity was measured with the Box and Block Test (BBT), and level of cognition was measured with the Mini-Mental State Exam (MMSE) in both groups at the beginning of the study and after the end of training (12th post-treatment weak). Data was gathered using the Purposive sampling method and data entered into SPSS-25 for statistical analysis.

Results: According to this study 74 participants, mean age was 53.21±12.02 male were 45(60.8%) and female were 29(40.2%). Mean Body Mass Index was 23.23±3.47. Right Side was affected among 32(43.2%) and Left Side was affected among 42(56.8%) Sensory Motor Function mean was Pretreatment 66.70±26.88 and Post-treatment 110.09±11.91. Level of Cognition mean was pretreatment 22.62±3.30 and Post-treatment 29.31±1.47. Dexterity mean Pretreatment was 8.18±11.64 and Post-treatment was 84.48±15.03. P Value was 0.00 which was <0.005 which means that there was significant difference between the mean value of pretreatment and post-treatment sensory motor function, Level of Cognition and Dexterity. There was significant difference between the mean value of Group A and B in sensory motor function, Level of Cognition and Dexterity as the P Value was 0.027, 0.04 and 0.02 respectively.

Conclusion:

Perfetti's method was more effective than routine physical therapy.

Comparative Effect of Augmented Reality and Routine Physical Therapy on Balance and Postural Control in Patients with Parkinson’s disease

Akasha Ahmad — 2024-03-31

Background: Parkinson's disease is a neurodegenerative condition that often manifests in old age with generalized slowness of movements (bradykinesia) and a minimum of one additional symptom of tremor at rest or stiffness.

Objective: The purpose is to compare the effects of Augmented Reality and Routine Physical Therapy on balance and Postural Control in Patients with Parkinson's disease.

Methodology: It was a randomized clinical trial done in the Neuro medicine and physiotherapy department of Allied Hospital, Faisalabad. A sample size of 62 patients was divided into two equal groups. Patients in Group A had conventional physiotherapy, while those in Group B received augmented reality and conventional physiotherapy. Non probability sampling technique was used. Data was collected on the baseline and then data was collected after 8th weeks, and final data was collected after 12th weeks. Tools for collection of data were the Berg balance scale, timed up and go, and one leg stance test.

Results: An Independent sample t-test was used to check the difference between groups in pre and post intervention which shows the statistical difference in both groups after the 8th and 12th weeks of treatment. However, mean differences show that group B has more good results. Repeated measure analysis of variance also shows that there is a significant difference between treatment groups in the within-group analysis.

Conclusion: Our study concludes that an augmented reality regimen along with physiotherapy is beneficial for Parkinson’s patients to improve balance and postural control.

Key words: Augmented reality, Balance, Posture, Parkinsonism, Postural Equilibrium, Lewy Body Parkinson Disease.

Comparison between Work Related Musculoskeletal Wrist Pain and Carpal Tunnel Syndrome among Students of Figurative Painting and Calligraphy

Shifa Muzammil — 2024-03-31

Objective: To compare painting related variables for carpal tunnel syndrome (CTS) and musculoskeletal wrist pain among students of calligraphy and figurative painting.

Methodology: A comparative cross-sectional study was conducted on 212 participants from 21 January to 25 May 2023. The data was collected from the fine arts departments of public and private universities in Sialkot, Pakistan. Phalen’s clinical test was used to screen the CTS and Boston carpal tunnel questionnaire was used as an outcome measuring tool. SPSS version 22 was used to analyze the data. Mean, Standard deviation and Independent-t-test was used to compare the groups at significance level (p=0.05).

Results: Out of 212, (N=148, 69.81%) were participants in figurative painting (group A) and (N=64, 30.18%) were in calligraphy (group B) with positive Phalen test. The total mean score of symptom severity scale for CTS was (26.49 ± 6.25) and functional status (21.26±7.58) which determines moderate difficulty with routine tasks. The symptom severity scale for CTS among groups A and B had mean scores (27.83 ± 6.20) and (23.40, ± 5.20) whereas the functional status scale among group A; had mean scores (23.20 ± 7.67) and B (16.79, ± 5.13) respectively. Factors that showed significant difference between painters and calligraphers BCTQ were working hours, medium of paints, size of paint brushes and types of paint brushes (p-value= 0.00).

Conclusion: The results of this study showed an overall 'moderate' symptom severity and functional difficulty level among participants with CTS but figurative painters were more affected in some factors than calligraphers.

Keywords: Painters, figurative, calligrapher, Carpal tunnel syndrome

Effects of Eccentric Tyler Twist Extensor-Strengthening Exercises in Lateral Epicondylitis

Rimsha Jalil — 2024-03-31

Background: Lateral epicondylitis, commonly known as tennis elbow, is characterized by pain and functional limitations at the elbow due to overuse. This study focuses on evaluating the effects of Tyler twist wrist extensor-strengthening exercises, aiming to provide insights into an effective intervention for this condition.

Objective: This study aimed to determine the effects of Tyler twist wrist extensor strengthening exercises on pain, disability, and grip strength in patients with lateral epicondylitis.

Methodology: A randomized controlled trial was conducted at Cina Medical Center Rawalpindi from February 2022 to January 2023. Fifty-two participants meeting the inclusion criteria were assigned to either Group A or Group B. Group A received eccentric Tyler twist exercises in addition to conventional physiotherapy, while Group B received conventional physiotherapy alone. Pain, functional disability, and grip strength were assessed at baseline, the second week, and the fourth week. Data was analyzed with SPSS version 25. Demographics and descriptive data is presented in form of percentages, frequencies and mean + SD. Normality of the data is determined via Shapiro Wilk Test. We applied mixed-way ANOVA to find the interaction between two groups.

Results: Within-group analysis demonstrated a significant improvement in pain, functional disability, and grip strength for both groups (p-value < 0.01). Between-group analysis revealed a significant difference in pain, functional disability, and grip strength.

Conclusion: The addition of eccentric Tyler twist exercises to conventional therapy showed a statistically significant difference in terms of pain, functional disability, and grip strength in patients with lateral epicondylitis.

Keywords: Extensor Carpi Radialis Brevis, Lateral Epicondylitis.

Factors Associated with Post-Traumatic Stress Disorder in Covid-19 Survivors; Cross-Sectional Study

Hassan Sarwar Hassan Sarwar — 2024-03-31

Background: A new air-borne pandemic COVID-19 had resulted in a large number of morbidity and deaths. Post-traumatic stress disorder used to begin three months after its origin and probably lasts for 6 months.

Objective: To determine the association of factors with post-traumatic stress disorder in COVID-19 survivors after getting normal confirmed by COVID19 negative test done through RTPCR diagnostic testing.

Methodology: According to Epitool a total of 165 COVID-19 survivors participated in this cross-sectional study. The non-probability convenient sampling approach was utilized. Demographic data was recorded using a self-made proforma while evaluation of post-traumatic stress disorder was done through IES-R scale.

Results: A total of 165 Covid-19 survivors took part in study, comprised upon 81 (49.1%) of men and 84 (50.9%) of females. The majority of COVID-19 survivors socioeconomically were from middle class in number of 148 (89.7%). About 66 (40.0%) encountered high impact post-traumatic stress disorder while surviving corona virus. COVID-19 survivors had trouble sleeping, being woken without cause, or over-slept, about 114 (69.1%) favored it whereas 51 (30.9%) opposed it. While 85 (51.5%) of COVID-19 survivors felt chest pain, tightness in chest or shortness of breath like symptoms after battling disease whereas 80 (48.5%) survivors had no impact.

Conclusion: The study determined that majority of COVID-19 survivors suffered from post-traumatic stress disorder had stronger association with the factors like nervousness, anxiousness and panic like stuff after surviving pandemic along with trouble in sleeping, staying asleep, awakened without reason or had overslept. While in comparison moderate association was configured between respiratory like symptoms including chest discomfort, heart beating and post-traumatic stress disorder in survivors who had battled out COVID-19.

Keywords: COVID-19, Post-Traumatic Stress Disorder, Sleep discomfort, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2.

Comparative Effects of Kabat Rehabilitation and Kinesiotaping on Functional Disability, Synkinesis and Patient Satisfaction in Patients with Bell’s Palsy

Anza Amjad — 2024-03-31

Background: Bell's palsy is when one side of the face suddenly becomes paralyzed. This can cause problems with how the face moves and feels. Two different therapies, Kabat Rehabilitation and Kinesiotaping, have been used to try to make people with Bell's palsy feel better.

Objective: To compare effects of Kabat rehabilitation and Kinesiotaping on functional disability, synkinesis and patient satisfaction in patients with bell’s palsy.

Methodology: In a study with 72 participants aged 20 to 60, all diagnosed with Bell's palsy for less than two weeks, individuals were split into two groups. Group A underwent a treatment called Kabat Rehabilitation, while Group B received both Kabat Rehabilitation and Kinesiotaping. The study evaluated how well the face moved, unwanted facial movements, and patient satisfaction using specific measures. These evaluations were conducted at the beginning, middle (Week 3), and end (Week 6) of the study.

Results: In a study of Bell's palsy treatments, Kabat Rehabilitation and Kinesio Kabat Rehabilitation were compared. By Week 6, the Kinesio Kabat group demonstrated greater improvements in physical function (Avg Diff.=-6.97, P<0.001), social function (Avg Diff.=-10.36, P<0.001), and synkinesis (Avg Diff.=-3.25, P=0.024), with higher patient satisfaction (P=0.001). The results favor the Kinesio Kabat Rehabilitation approach based on these numerical evaluations.

Conclusion: Both Kabat Rehabilitation and Kinesiotaping are effective in improving functional disability and synkinesis in Bell's palsy patients. Kabat Rehabilitation showed slightly greater benefits in patient satisfaction at the later stage of treatment. These findings provide valuable insights into the efficacy of these rehabilitation techniques for Bell's palsy and highlight the importance of considering patient satisfaction as an essential outcome measure. Larger studies with longer follow-up periods are warranted to validate and expand upon these findings.

Keywords: Bell's palsy, Kabat Rehabilitation, Kinesiotaping, functional disability, synkinesis, patient satisfaction, physiotherapeutic interventions.

Effects of Treadmill Training on Gross Motor Function, Spasticity and Gait Speed in Ambulatory Children with Spastic Cerebral Palsy

Yasir Butt — 2024-03-31

Background: Cerebral palsy is described as a permanent, non-progressive disorder related to neurodevelopmental abnormalities in an underdeveloped brain which leads to additional brain lesions resulting in secondary motor disturbances and postural abnormalities

Objective: To determine the effectiveness of treadmill training on gross motor function, spasticity and gait speed in ambulatory children with spastic cerebral palsy.

Methodology: It was a Randomized clinical trial, which was done in Bahria International Hospital, Lahore by convenient sampling technique. A sample size of 50 patients were divided into two groups. Patients in Group A underwent conventional physiotherapy, whereas those in Group B received a specialized treadmill training program tailored for children with spastic cerebral palsy, alongside their standard physical therapy sessions.

Result: Our data is normally distributed so wo applied Independent sample t test for between group analysis which shows that mean of group A at baseline is 5.40±0.49 and group B is 5.20±0.76, at 6th weeks group A is 4.80±0.48 and group B is 4.33±.0.88and at 12th weeks group A is 3.93±0.58 and group B is 2.13±0.68.p-value shows that there is no significant difference between two groups at baseline and at 6th weeks but at 12th weeks there is a significant differences as p-value is less than 0.00.Repeated measure ANOVA shows both groups shows significant results but meand difference of treadmill training group were more in all outcome.

Conclusion: - Our study concludes that treadmill training, along with physiotherapy, is beneficial for children with spastic cerebral palsy in improving gross motor function, spasticity, and gait speed.

Keywords: Treadmill exercise, Gait, Spasticity, cerebral palsy

Telerehabilitation! Is it time to rethink Neurorehabilitation services in Pakistan?

Ayesha Ahmad — 2024-03-31

Telemedicine also known as Telehealth is a mean to support healthcare by using communication technology when there is distance between the participants.¹ The healthcare system changed after the COVID-19 pandemic which expanded telehealth. Telerehabilitation has however been used as an adjunct to the in-person care instead of completely replacing it.² For both medicine and surgery, the technologies used for telemedicine have recently gained popularity. Telemedicine has become a source of diagnosis and treatment by the use of telecommunication in remote areas. It helps people living in areas with shortage of medical facilities have an access to healthcare. Although arguments have been raised regarding in-person limitation, patient satisfaction and reduced quality of healthcare, there are various studies that have proved to be contrary.³

Telerehabilitation has been efficient in dealing with various neurological disorders including Parkinson's disease (PD). The characteristics of neurological diseases like progression, mobility concerns and unequal distribution of qualified and trained healthcare professionals makes an in-person session difficult.¹

Some conditions other than parkinsonism, dementia, epilepsy and headache have also been replaced by telerehabilitation. Saporta et al (2020) proposed a tele-approach model for patients having neuromuscular conditions. The MRC score for strength was assessed through performance of specific tasks and sensory evaluation was done using cotton swabs or pin after guiding the caregivers. Adequate caregiver training can also be utilized for examination of other signs including balance, gait and cerebellar tasks. Repetitive virtual activities to evaluate fatigue can be performed to assess specific diseases like Myasthenia Gravis. Scales like inflammatory Rasch-built Overall Disability Scale (i-RODS) and ONLS can be used to measure upper and lower limb disability through daily life tasks that have been limited by the neurological conditions, they help in quantifying the disease.⁴

According to a study conducted by Alessandro et al (2019), telerehabilitation along with other techniques caused functional and psychological improvements in a patient of facial palsy.⁵ According to a systematic review by Asma Alonazi (2021) children having restricted access to physical therapy specially during Covid-19 and having conditions like autism, cerebral palsy, neuromuscular diseases, neurodevelopmental disorders etc benefitted from telerehabilitation.⁶

Telerehabilitation requires creative physical therapy approaches that have been used manually until now. It is a hope for better healthcare facilities in the areas of Pakistan where physical therapy is hard to reach through professionals. Although there is more to explore in telerehabilitation, it is worth applying, it will help in keeping rehabilitative services from saturating in certain areas of the country.

References:

Demartini B, Bombieri F, Goeta D, Gambini O, Ricciardi L, Tinazzi M. A physical therapy programme for functional motor symptoms: a telemedicine pilot study. Parkinsonism & Related Disorders. 2020;76:108-11.
Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, et al. Outpatient physical, occupational, and speech therapy synchronous telemedicine: a survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. American journal of physical medicine & rehabilitation. 2020.
Piche J, Butt BB, Ahmady A, Patel R, Aleem I. Physical examination of the spine using telemedicine: a systematic review. Global Spine Journal. 2021;11(7):1142-7.
Spina E, Trojsi F, Tozza S, Iovino A, Iodice R, Passaniti C, et al. How to manage with telemedicine people with neuromuscular diseases? Neurological Sciences. 2021;42(9):3553-9.
de Sire A, Marotta N, Agostini F, Drago Ferrante V, Demeco A, Ferrillo M, et al. A telerehabilitation approach to chronic facial paralysis in the COVID-19 pandemic scenario: what role for electromyography assessment? Journal of Personalized Medicine. 2022;12(3):497.
Alonazi A. Effectiveness and acceptability of telerehabilitation in physical therapy during COVID-19 in children: findings of a systematic review. Children. 2021;8(12):1101.

Advancing Scope of Women’s Health Physical Therapy: Navigating Challenging and Expanding Horizons in Pakistan

Huma Riaz — 2024-03-31