Physiotherapy for chronic rhinosinusitis: The use of continuous ultrasound

Chronic rhinosinusitis (CRS) is the most common chronic disease in the field of ear, nose and throat and is often very difficult to treat. The aim of this pilot study was to determine the effects of continuous ultrasound (US) on CRS. In a randomized, single-blind, placebo-controlled study, 20 patients were treated with either continuous US (n = 10) or mock-US (n = 10), 3 days a week for 10 treatment sessions. All patients improved after treatment with US. Excellent and good improvements were observed in nine patients. Between-group comparisons of �percent improvement� showed a significantly higher improvement in the US group than in the control group. The total scores of rhinosinusitis symptoms were significantly improved after treatment in both the groups. At one-month follow-up, eight patients in the US group reported no recurrence of the disease and the CRS had recurred in all patients of the control group. This trial demonstrates that continuous US may be an effective tool in the treatment of patients with CRS, although further study is needed. © MA Healthcare Limited 2014

Efficacy of a physical training program on pregnancy related lumbopelvic pain

Objectives: A large number of women suffer from lumbopelvic pain during pregnancy. This pain continues in considerable percentage of women after pregnancy and causes considerable distress and disability. The purpose of this study was to investigate the efficacy of a physical training program on lumbopelvic pain and its physical disability during pregnancy. Materials and Methods: A quasi-experimental study was performed to investigate the effects of a physical training program in women with lumbopelvic pain in 2010-2011. A total of 180 pregnant women were randomly assigned to the intervention (n = 90) and control groups (n = 90). The physical training program consisted of stretching and strengthening exercises and body posture modifications. This 12-week program was administered to the intervention group only and the control group received the routine prenatal care. The main outcome for measurement were pain and physical disability that was assessed at baseline and 12 weeks post treatment by visual analog scale (VAS) and Oswestry Disability Index, respectively. Results: There was no significant difference in pain intensity and physical disability between groups before intervention (P > 0.05), however pain and physical disability decreased significantly in the intervention group (P < 0.05). Conclusions: It seems that a designed physical program and body postures modification may reduce the severity of lumbopelvic pain and its related disability in pregnant women. It is recommended that midwives emphasize the importance of back pain and pelvic pain in prenatal counseling sessions and provide solutions for pain relief, including physical exercise and posture modification. © 2018 The Author (s)

The immediate effects of dry needling for ankle and toe plantar flexors on spasticity and balance in patients with stroke

Background: Spasticity is one of the most important symptoms of stroke, which leads to movement constraints and disability. The presence of spasticity in the ankle and toe plantar flexor muscles disturbs the balance and gait of patients with stroke. Dry needling has been introduced as a new method for the treatment of spasticity. The aim of this study was to investigate the immediate effects of the ankle and toe plantar flexors dry needling on spasticity and balance in patients with stroke. Methods: This study was a clinical pretest-posttest study. Twenty patients with stroke (12 males and 8 females), the mean age of 56.5±13 years were included. The assessments were performed before dry needling, immediately after dry needling and 15 minutes after that. Dry needling was used to treat gastrocnemius (ankle plantar flexor) muscles, flexor digitorum longus, and flexor digitorum brevis of the affected lower limb of the patients, for one session. Each muscle was needled for one minute with fast in-fast out technique. The outcome measures of the study were modified modified Ashworth scale (MMAS) for the assessment of the severity of muscle spasticity, timed up and go test and one leg stance test, for balance evaluation. The study was conducted in neurological physical therapy, Clinic of Rehabilitation School, Tehran University of Medical Sciences in Iran, from April 2017 to April 2018. Results: The results showed a significant decrease in the ankle and toe plantar flexor muscles spasticity both immediately after dry needling and at 15 minutes follow-up (P=0.001). The duration of timed up and go test (P=0.001) and one leg stance test (P=0.001) improved significantly after dry needling and this improvement persisted for 15 minutes after dry needling. The effect size for timed up and go test and one leg stance test was small (Cohen'sd=0.33 and 0.32 respectively). Conclusion: This study suggests that dry needling is effective in improving spasticity of ankle and toe plantar flexor muscles and the balance of patients with stroke. Further research with larger sample size and control group is necessary. © 2020 Tehran University of Medical Sciences. All rights reserved

Efficacy of a physical training program on pregnancy related lumbopelvic pain

Objectives: A large number of women suffer from lumbopelvic pain during pregnancy. This pain continues in considerable percentage of women after pregnancy and causes considerable distress and disability. The purpose of this study was to investigate the efficacy of a physical training program on lumbopelvic pain and its physical disability during pregnancy. Materials and Methods: A quasi-experimental study was performed to investigate the effects of a physical training program in women with lumbopelvic pain in 2010-2011. A total of 180 pregnant women were randomly assigned to the intervention (n = 90) and control groups (n = 90). The physical training program consisted of stretching and strengthening exercises and body posture modifications. This 12-week program was administered to the intervention group only and the control group received the routine prenatal care. The main outcome for measurement were pain and physical disability that was assessed at baseline and 12 weeks post treatment by visual analog scale (VAS) and Oswestry Disability Index, respectively. Results: There was no significant difference in pain intensity and physical disability between groups before intervention (P > 0.05), however pain and physical disability decreased significantly in the intervention group (P < 0.05). Conclusions: It seems that a designed physical program and body postures modification may reduce the severity of lumbopelvic pain and its related disability in pregnant women. It is recommended that midwives emphasize the importance of back pain and pelvic pain in prenatal counseling sessions and provide solutions for pain relief, including physical exercise and posture modification. © 2018 The Author (s)

A preliminary study into the effect of low-intensity pulsed ultrasound on chronic maxillary and frontal sinusitis

Sinusitis is a very common acute or chronic illness that affects a significant percentage of individuals. Recently, therapeutic ultrasound was reported as a treatment for chronic sinusitis. The purpose of this study was twofold: 1) to evaluate the effectiveness of low-intensity pulsed ultrasound (US) in chronic sinusitis using a pretest-posttest research design and 2) to determine the level of association between the independent variables of initial presence of symptoms, age, gender, and duration of disease and the dependent variable of improvement of symptoms. Patients with chronic sinusitis were treated with low-intensity pulsed US, 3 days per week for 15 sessions. Fifty-seven patients (18 females and 39 males; mean age, 35 years) were included in the study. The results of the McNemar test showed a significant change in proportions of post nasal drip and nasal obstruction, two common leading symptoms of patients with chronic sinusitis (p < 0.001). Most of the major and minor symptoms showed significant changes after US therapy (p < 0.05). The total improvement of symptoms was 81.3. The greatest improvement in symptoms was observed in nasal discharge (100), followed by facial pain (95.4) and postnasal drip (82.7), three major factors in sinusitis. There was a significant, low association between the initial presence of symptoms and the improvement of symptoms after US therapy (�2 = 30.352; df = 12; p = 0.002; phi value = 0.356). A significant, low association was also noted between the age and the improvement of symptoms after intervention (�2 = 17.548; df = 6; p = 0.007; phi value = 0.270). It may be concluded that low-intensity pulsed US has a significant effect on chronic sinusitis and improves patient symptoms in our study group. Copyright © Informa Healthcare

A new biomechanical method for objective measurement of spasticity: A preliminary study

The assessment of the various impairments in brain damage including spasticity is important. The purpose of this study was to develop a new biomechanical method based on quantification of velocity reduction (VR) suitable for clinical use. A highly reliable system was developed to apply a constant torque perturbation at the elbow. This system was used to measure the VR in 30 healthy adults and 10 hemiplegic patients. In healthy subjects, the mean VR was 3.02 (SE (standard error) = 0.29). In hemiplegic patients, the mean VR in the impaired arm (81.47, SE= 2.87) was significantly higher than the VR () either in the nonimpaired arm (9.86, SE= 0.92) (WSRT (Wilcoxon Signed Ranks Test): Z = -12.74; p<0.001), or the normal (3.02) p<0.001). The interaction between the associated reaction (AR) and the asymmetrical tonic neck reflex (ATNR) with head away from the impaired arm made a significant higher VR (90.41, SE=3.43) (p<0.001). The correlation between the VR () and the Modified Ashworth Scale scores was significant (Spearman�s rho = 0.77, p<0.001). It is concluded that the quantification of velocity reduction may be used as an objective method of measuring spasticity in neurological conditions. © MA Healthcare Limited 2014

The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial

Background: Dysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients. Objectives: This study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia. Methods: A pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T 0 ), after the end of 9th session (T 1 ), after the end of 18th session (T 2 ), and after 6 weeks follow-up (T 3 ). Penetration�Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T 0 and T 2 . Results: Both groups had improved regarding MASA, PAS and PRRS scores over the time (P &lt; 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time � Group interaction was significant for MASA score (P &lt; 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups. Conclusions: This pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia. © 2018 Elsevier Lt

A study on the immediate effects of plantar vibration on balance dysfunction in patients with stroke

The aim of this study was to estimate the immediate effects of plantar vibration, applied to the more affected foot, on balance impairment in patients post-stroke. This pretest-posttest clinical study included 18 pa-tients (13 men) poststroke; mean age 56.0±8.9 years (range, 41-71 years). One session of 5-min vibratory stimuli (frequency, 100 Hz) was applied to the plantar region of the more affected foot of all participants. The plantar vibration significantly improved the Timed UP and Go test (P=0.03, Cohen d=0.15), ankle plantar flexor muscle spasticity (P=0.008), and ankle passive range of motion (P 0.05). Vibration stimuli applied to the plantar re-gion of the more affected foot had significant effects on spasticity, ankle passive range of motion and dynamic balance as evaluated by the Timed Up and Go test in patients poststroke. There was no effect on static balance performance. Based on the results, the focal vibratory stimuli applied directly to the plantar region of the more affected foot may be recommended to improve the functional mobility and dynamic balance in patients with stroke. © 2018 Korean Society of Exercise Rehabilitation

A preliminary study into the criterion validity of the modified Modified Ashworth scale using the new measure of the alpha motoneuron excitability in spastic hemiplegia

The Modified Ashworth Scale (MAS) is the most widely used clinical test for the measurement of muscle spasticity. This scale that suffers from limitations and lack of reliability and validity has recently been remodified. The aim of the present study is to investigate the criterion validity of the new Modified MAS(MMAS) in the upper limb in post-stroke hemiplegia, using the Hslope/Mslope (Hslp/Mslp) as a novel index of alpha motor neuron excitability. Prior to the validity study, the reliability of the MMAS was evaluated in 30 hemiplegic patients. The raters agreed on 23 patients (0.76). The MMAS had good inter-rater reliability (κ= 0.63, SE = 0.11, p 0.05): There was also no relationship between the clinical scale of MMAS and either the traditional Hmax/ Mmax ratio (r = -0.06) or the new index Hslp/Mslp (r = 0.24) of spinal excitability. This preliminary study recruited a small number of patients, and failed to confirm a linear correlation between these variables. A study with a larg number of patients is suggested to clarify the outcome

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved