Pathophysiology, Functional Implications and Management of Spasticity in Stroke – A Review

The management of spasticity in stroke requires a multidisciplinary approach but more importantly, an understanding of the pathophysiology of its consequences. This paper reviews different definitions from neurophysiology and medical literature which try to place spasticity in stroke in its proper context and describes the current understanding of its pathophysiology and resultant functional implications. It also highlights the current medical, surgical and physical therapy available for its management. It seems spasticity in stroke is best managed using a combination of physiotherapy and Botulinum Toxin- Type A injection, as this is the current trend in research and practice. Keywords: Spasticity, strok

Potential Hazards and Possible Safety Precautions in Electrotherapy

The use of various electrotherapeutic modalities in physiotherapy is known to offer beneficial effects for patients for whom the modality has been found to be clinically suitable. However, there are a few grey areas that need to be addressed in order to maximize the benefits derived from the use of these modalities. Though these modalities have direct benefits for the patients, the physiotherapist, support staff and students, and even the patient are exposed to some danger from, or related to, their use, unless certain safety  precautions are instituted. This article presents the potential dangers associated with different electrotherapeutic modalities and the possible preventive measures that could be undertaken to protect individuals likely to be exposed to these dangers.KEYWORDS: hazards, safety, precaution, electrotherap

Physical Activity, Dietary Intake and Anthropometric Indices of a Group of Nigerian University Undergraduates

This study explores the interrelationships among the physical activity level, dietary pattern and anthropometric indices of some pre-clinical undergraduates in a university in southeastern Nigeria. One hundred and twenty-one (121) consecutively-recruited volunteers (57 male and 64 female), aged 19-29 years, who were pre-clinical students participated in the study. Information on physical activity level (PAL), dietary pattern and anthropometric characteristics as well as demographics was collected. About 80% of the male and female participants had normal weight. Fewer males (11.1%) than females (17.6%) reported low PAL. Fewer males (5.7% and 7.7%) tended to have undesirable waist circumference (WC) and waist-hip ratio (WHR) than the females (16.2% and 41.2%). Also fewer males (24.1%) tended to have a high fat intake than females (30.9%). However, more males (87.0%) tended to take low amounts of fruit/vegetable (FV) than females (79.4%), whereas more females (89.75%) tended to take low amount of fibre than the males (57.4%). The females had a higher (P<0.05) WHR than the males, while the males consumed more fibre (P<0.05) than the females. Fat intake correlated very significantly (P<0.05) with WC. Fibre intake correlated very significantly (P<0.05) with WC and WHR, while PAL correlated significantly with only BMI and WC. Although the prevalence of general obesity is not alarming in this sample, a sizeable number of the respondents have the tendency to be obese and also have central obesity. Fruits and vegetables and fibre consumption were generally low

Quality of life of mothers of children with cerebral palsy and their agematched controls

Background Caring for a child with cerebral palsy (CP) could negatively impact the quality of life (QoL) of the mothers who are usually the primary caregivers. Studies on the impact of caring for Nigerian children with cerebral palsy on the mothers’ quality of life are not common hence the quality of life of mothers of children with cerebral palsy (MCCP) and age-matched mothers of typically developing children (MTDC) were compared in this study.Methods Eighty mothers (40 MCCP and 40 MTDC) participated in this cross-sectional survey. Participants in both groups had their quality of life assessed using the World Health Organization Quality of Life BREF (WHOQoL-BREF). Data were analyzed using independent t-test, Chi-square and Mann-Whitney U tests with alpha level set at 0.05.Results The two groups were not significantly different in their ages (p = 0.14). The mean overall QoL score of the MCCP (62.83±17.83) was significantly lower than that of the MTDC (68.87±8.51) (U=590.0; p=0.04) just as scores for overall health perception (U=576.5; p=0.03). Religion, educational status and occupational status had no significant influence on the QoL scores of mothers of children with cerebral palsy.Conclusion Caring for a child with CP significantly impacted on the QOL and health of the mothers, irrespective of their socio-economic status. Measures to improve quality of life and health of mothers of children with cerebral palsy should be incorporated in the management of CP with emphasis on identified areas of need.Key words: Caregivers, Cerebral Palsy, Quality of Life, Typically Developing Childre

Quality of life and sex-differences in a South-Eastern Nigerian stroke sample

BackgroundQuality of Life (QOL) studies in stroke among Africans are rather few and mainly from South-Western Nigeria. Hardly is there any from the other regions of this vast nation. Reports on gender influences on stroke survivors’ QOL have also been contradictory.ObjectivesThis study set out to provide preliminary data on the QOL of stroke survivors in South-Eastern Nigeria and also investigate sex-differences in the QOL.MethodsOne hundred and three volunteering stroke survivors (53 males, 50 females) were recruited from various settings. The Stroke-Specific Quality of Life (SS-QOL) scale was used to assess participants’ QOL. Participants mean QOL score in the overall and individual domains were presented as percentages of Maximum Possible Scores (MPS) while sex-differences across domains were investigated with Mann-Whitney U test statistics at 0.05 alpha level.ResultsParticipants mean scores in the vision (12.44 ± 3.56), thinking (11.50 ± 3.71), mood (18.55 ± 4.81) and language (19.04 ± 6.81) domains were above 70 percent of MPS while mean score in the social role (11.82 ± 4.75) was below 50% of MPS. Overall QOL score was slightly below 70% of the MPS. No significant sex-difference was found in all the SS-QOL domains (p<0.05).ConclusionsQOL seems to be affected, albeit not too severely, among stroke survivors from South-Eastern Nigeria. The effect is however similar for survivors of both gender. Social and family roles and physical functioning seem to be areas requiring keener clinicians’ attention.Key words: Stroke, Quality of life, Sex-differences, South-Eastern Nigeria

Determination of hand grip strength and its correlates during pregnancy : a cross-sectional study

Background: Pregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy. Methods: The study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression. Result: One hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength. Conclusion: Cardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women

Mechanisms of sports injuries among professional footballers: A Review

Football is an impact collision sport, with injuries occurring in both contact and non-contact situations. Injuries may be caused by complex interactions between internal and external risk factors. The internal factors such as age, sex, and body compositions may influence the risk of sustaining injuries, predisposing the player to injury, and are therefore by definitions risk factors. The main purpose of this study was to review articles and draw attention to the prevalence, severity and mechanism of football injuries. A review of 22 published articles was done using the Health internetwork access to Research (HINARI) Database. Search terms were sport injuries, injuries among Professional footballers, severity of football injuries, and prevalence of football injuries. Only articles in English literature were retrieved. No other search limit was set. prospective cohort, retrospective, cross sectional studies were chosen and in-depth interviews for review. Eleven articles were of prospective cohort study design; seven were retrospective studies, two cross sectional and two in- depth interview method. The articles revealed that the risk of injury in professional football is substantial; its prevalence astronomical and extremely severe. Injuries also affect performance in a negative way and teams that can avoid injuries have greater success as evaluated by their position in the league system. Prevention of injury in football is of utmost importance, and conducting an injury surveillance study is fundamental and first step in the sequence of prevention. On the mechanism of the injuries, their result showed that tackling/being tackled, jumping, landing, turning and twisting; running, shooting and collisions are the mechanism of football injuries. Most sprains occurred either after a tackling situation or after a change in direction It can be concluded from the review that the major mechanisms of traumatic football injuries were tackling/being tackled, jumping, landing, turning, falling and collisions with other players/opponents. Players’ age, role/position of play, history of previous injuries, and psychological factors (like self-confidence, fear, somatic trait anxiety, aggression, poor stress coping ability) were identified as predictors of sports injuries in most of the literatures that the researchers reviewed.Keywords: Collision, contact injury, non-contact injury, professional footballers, sports injuries

Isometric endurance of the back extensors in school-aged adolescents with and without low back pain

Background and objective: Studies on back extensor endurance in adolescents are scarce. This study sought to establish reference data and pattern of back extensor endurance in school-aged adolescents with and without low-back pain (LBP) from Nigeria. Subjects and methods: This study recruited 625 adolescents aged 11 to 19 years from eight randomly selected secondary schools. The modified Biering-Sørensen test of Static Muscular Endurance (BSME) was used to assess isometric endurance of the back extensors. Demographic and anthropometric data were collected. A modified LBP questionnaire was used to assess the presence of LBP. Descriptive and inferential analyses were used to analyze data. Significance was set at 0.05 α-level. Results: The mean isometric holding time (IHT) of all the participants was 132.9 ± 65.6. Males had significantly higher significant (p=0.026) IHT than females. Adolescents without LBP had a higher significant IHT (p=0.042) than those with reported history of previous LBP and those with present LBP (p=0.000) respectively. Using percentile values, poor endurance was defined as IHT that is 193 s and > 170 s for males and females respectively. IHT was significantly related to each of body mass index, hip circumference and waist-to-hip ratio (p < 0.05). Conclusion: Isometric back extensors endurance in Nigerian adolescents was comparable to the original Biering-Sørensen mean value. Majority of the participants had medium endurance performance with the back endurance pattern in the ratio 1:2:1. Male had higher isometric back extensors endurance than females. Decreased isometric back extensors endurance was associated with the presence of LBP in adolescents

Estimating utility values for health states of Nigerian individuals with stroke or epilepsy using the SF-36: a brief report on the results of a cross-sectional surveys

Background: Stroke and epilepsy are the most common neurological condition affecting individuals. The Short Form Six-Dimension Health Index (SF-6D is a preference-based measure of health developed to estimate utility values from the SF-36. This study estimated utility values for health states of Nigerian individuals with stroke or epilepsy using the SF-36. Methods: SF-36 responses from 125 and 69 individuals with stroke and persons with epilepsy, respectively were transformed into health state utility values using the SF-6D algorithm. The excel programme, developed by Brazier and colleagues was used to generate the SF-6D utility score estimated using a set of parametric preference weights. The health state utility values were determined using ordinal health state and standard gamble valuation techniques. Result: Mean (SD) ages of the stroke and epilepsy participants were 63.1 (11.1) and 39.6 (16) years respectively. The mean (SD) utility scores for stroke and epilepsy were 0.52(0.10) & 0.65(0.1) for standard gamble, 0.48(0.13) & 0.68(0.11) using the ordinal health state paradigm. The mean (SD) utility of stroke (Female = 0.46 (0.15); Male = 0.50 (0.12)) and epilepsy (Female = 0.65 (0.13), Male = 0.69 (0.11)) participants were reported. The mean (SD) annual episode seizure was 18.7(39). Conclusions: To our knowledge this is the first study to suggest that female with stroke and those with epilepsy considered their health to be poorer than that of their male counterparts. The significance of our findings is that they may be helpful for researchers, policy makers and clinicians by providing input to economic evaluations to facilitate resource allocation for stroke survivors and people living with epilepsy to improve their health outcomes and reduce the huge burden associated with the conditions

Prevalence of selected fall variables and relationship among them in a Nigerian stroke population

Objectives- This study investigated the relationships among the three fall indices of fall incidence (FI), fall risk (FR) and fear of falling (FOF)among stroke survivors in a Nigerian population.Design: Ex-post facto study with co-relational designMethods-This correlation study involved 26 stroke survivors (17 males, 9 females) recruited through consecutive non-probability samplingtechnique from two South-Eastern Nigeria teaching hospitals. The Modified Falls Efficacy Scale (MFES), Berg Balance Scale (BBS) and oralinterview were respectively used to assess fear, risk and incidence of falls of participants.Results- FOF prevalence in the studied population was 81% while actual fall prevalence was 19.2% within the 6months period preceding datacollection. Risk of falling was also present in about 70% of participants. FOF and FR both significantly correlated (