Acute flaccid paralysis: a five–year review of cases managed by physiotherapy at the University College Hospital, Ibadan

A 5-year (1999-2004) review of acute flaccid paralysis (AFP) cases managed at the physiotherapy clinic of the University College Hospital, Ibadan Nigeria was carried out. Collection of data involved retrieving the records of all patients seen at the physiotherapy clinic during the study period, from which the paediatric cases were sorted out. The treatment records cards of patients with acute flaccid paralysis were identified and reviewed. Information on age, gender, immunization history, and specific physician diagnosis and discharge practice were collated. A total of 757 paediatric cases reviewed out of which 132 (17.4%) were AFP case, with mean age of 44.31± 33.03 months and a 1.2:1.0 male: female ratio. Sciatic nerve palsy accounted for majority (72.0%) of the AFP; only 43.2% of the patients had completed immunization before the onset; majority of the cases (78.8%) were referred to physiotherapy within 6 months of onset and the discharge pattern revealed that only 9.8% of the patients were formally discharged. With injection palsy accounting for majority of the AFP cases, the need for caution. In administration of intramuscular injections at the buttocks of children with febrile illnesses is suggested. Importance of adequate documentation of clinical information by clinicians is also emphasised. African Journal of Health Sciences Vol. 13 (1-2) 2008: pp. 28-3

Interaction between anti-hypertensive and non-steroidal anti inflammatory drugs: implications in management of osteoarthritis and opinion on a compromise therapy

The premise for this article is that a significant proportion of patients presenting in the clinic with osteoarthritis have hypertension as co-morbidity. A common drug of choice in managing symptoms of osteoarthritis including those affecting the knee joint is the Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) groups. It has been reported however that NSAIDs diminish the effects of anti-hypertensive drugs and may lead to an ineffective hypertension therapy. In order to avoid complications in the health of the patient with concomitant hypertension and osteoarthritis and who are on both antihypertensive and NSAIDs, it becomes imperative to consider using non-pharmacologic approaches such as physiotherapy in managing the symptoms of osteoarthritis in this group of patients and thereby maximizing the effects of their antihypertensive therapy. This is more so that information exists on efficacy of physiotherapy in form of therapeutic exercises and electrotherapeutic modalities in management of clinical features of osteoarthritis.KEY WORDS: NSAIDS; Anti-hypertensive drugs; Interaction; Osteoarthritis; Managemen

Gross motor function classification system family questionnaire: validating Yoruba-Nigerian version

Background Assessment of the functional abilities of children with cerebral palsy would be more reliable if care givers are included. An instrument commonly used for assessing functional abilities in CP by their caregivers is the Gross Motor Function Classification System Family Questionnaire. No Nigerian Version of this instrument is currently available; hence this study was designed to evaluate the criterion- related validity of the Yoruba (Nigerian) version of the GMFCSFQ among care givers of children with cerebral palsy.Method Fifteen primary caregivers of children with CP, who are fluent in speaking, reading, and writing both English and Yoruba Languages, were purposively sampled from among those bringing their children or wards for physiotherapy at the University College Hospital Nigeria and involved in this study. The participants completed within one week interval, the English and Yoruba versions of the GMFCSFQ by choosing one of the five ordinal levels corresponding to the gross motor function of their children. Spearman’s correlation coefficient was used to examine the relationship between the scores from the English and the Yoruba versions of the instrument. Significant level was set at ά=0.05.Results A strong positive and significant correlation was obtained between the English and Yoruba Versions of the GFMCSFQ (ρ=0.89, p=0.00).Conclusion This suggests that the Yoruba version of the GMFCSFQ is a valid version of the original (English) version. It could therefore be used to gather information about the gross motor function of children with cerebral palsy from their family members or caregivers among Yoruba speaking people of West Africa and in Diaspora.Key words: Cerebral Palsy, Gross Motor Function, Yoruba

Comparison of Community Reintegration and Selected Stroke Specific Characteristics in Nigerian Male and Female Stroke Survivors

This study investigated the difference between community reintegration of male and female stroke survivors and the association between gender of stroke survivors and some selected stroke specific characteristics (type,side of paresis and occurrence) Fifty-two patients (25 males and 27  females) recruited from hospitals in Nigeria took part in the study. Community reintegration (CR) was assessed three months post-admission discharge using the Reintegration to Normal Living Index (RNLI).  Demographic and stroke-specific characteristics were obtained using a dataform. Data were analysed using descriptive statistics, the Mann-Whitney U test and the chi-square test. Level of significance was set at p = 0.05.The mean age of the participants was 61.21 ± 11.25 years (range 31 – 86 years). There was no significant difference (p = 0.173) between the community reintegration scores of male and female participants. There wasalso no significant association between gender and each of the selected stroke specific characteristics such as type of stroke (p = 0.279); side of paresis (p = 0.250) and occurrence of stroke (p = 0.670). Community reintegration scores of male and female stroke survivors are not  significantly different. There is no significant association between gender and each of the selected stroke specific characteristics.KEYWORDS: community reintegration, stroke, stroke survivors,  participation, gende

Functional Ability, Community Reintegration and Participation Restriction among Community-Dwelling Female Stroke Survivors in Ibadan

Background: Stroke is not gender-discriminatory. Yet, the subject of stroke among females has apparently not received significant attention from clinical researchers. The consequences of stroke include functional and psychosocial sequelae which may cause disability, hinder community reintegration and restrict participation. The inter-relationships among functional ability, community reintegration and participation restriction of community-dwelling, female stroke survivors in Ibadan were assessed in this descriptive study.Methods: Fifty-two community-dwelling female stroke survivors (mean age = 56.55±9.91 years) were surveyed using consecutive sampling technique. Their functional ability level was measured using the Functional Independence Measure (FIM) while London Handicap Scale (LHS) was used to assess their participation restriction. Data were analyzed using Spearman Rank Correlation Coefficient (rho) and Mann-Whitney U test at p = 0.05.Results: Significantly positive correlations (p< 0.05) were found between functional ability and community reintegration (r = 0.54; p = 0.01) as well as between participation restriction and community reintegration (r = 0.34; p = 0.05). Individuals with left hemiplegia had significantly higher mean rank scores in functional ability (30.41) than those who had right hemiplegia (mean rank scores = 21.94).Conclusion: Functional ability which appears to be related to stroke laterality showed positive association with both community reintegration and participation restriction. This suggests that improving the functional ability of the stroke survivors may reduce participation restriction and enhance their reintegration into the community. A similar study which compares male and female stroke survivors in the same community is thus necessary.Keywords: Stroke, Functional ability, Community Reintegration, Participation Restrictio

Physiotherapy Management of Faecal Impaction: A case report*

This case report describes how a physiotherapy modality was used to resolve faecal impaction. A 38-year old man developed faecal impaction after 8 weeks of intensive medical care. A physiotherapist was invited to apply a suitable modality that could bring relief to the patient. The pre-treatment measurement of the distended abdomen was 102 cm. Modified passive mobilization of the lower limbs towards the abdominal surface was carried out. After 6 sessions, the faecal impaction was resolved. The post-treatment measurement of the abdomen was 86.5 cm. This case demonstrates the important role of a physiotherapy modality in the management of faecal impaction. It is hoped that this study will stimulate the interest of physiotherapists in the management of this condition. KEY WORDS: faecal impaction, megacolon, modified passive mobilization, abdominal distention *This case report was presented at the 46th Annual Scientific Conference of the Nigeria Society of Physiotherapy, November 2006

The perception of disability by community groups: Stories of local understanding, beliefs and challenges in a rural part of Kenya

Cultural narratives on disability have received much attention over the past few decades. In contexts of poverty, limited information and everyday challenges associated with having, or caring for someone with a disability, different understandings have emerged. A project was set up to promote disability awareness in neighborhood communities in a rural part of Kenya, using a process of reflection and education. This paper reports on the first aspect–reflection. The aim was to investigate local understanding of disability as a co-constructed concept. The research questions were: 1. What cultural beliefs shape local understanding of disability? 2. What challenges are perceived to be associated with disability? A phenomenological approach was adopted. Focus group discussions were conducted with twenty-one community groups involving 263 participants and audio-recorded. The data were transcribed and thematic analysis was carried out. Visual maps were created to illustrate any interconnections, before establishing the final conclusions. Local beliefs attributed disability to: human transgression of social conventions, particularly concerning inappropriate family relations, which invoked a curse; supernatural forces affecting the child; the will of God; unexplained events; and biomedical factors. Challenges associated with disability related to the burden of caregiving and perceived barriers to inclusion, with stress as a shared bi-product. Local understanding of disability in this rural part of Kenya demonstrated overlapping explanations and plurality of beliefs. Two possible interpretations are offered. Firstly, oscillation between explanatory lines demonstrated instability, affecting broader acceptance of disability. Secondly, and more positively, in the face of challenges, the desire to make sense of the existing situation, reflected a healthy pluralism

How to improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids--canes and an orthosis TheraTogs--on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomised control trial

<p>Abstract</p> <p>Background</p> <p>Annually, some 9000 people in Switzerland suffer a first time stroke. Of these 60% are left with moderate to severe walking disability. Evidence shows that rehabilitation techniques which emphasise activity of the hemiplegic side increase ipsilesional cortical plasticity and improve functional outcomes. Canes are commonly used in gait rehabilitation although they significantly reduce hemiplegic muscle activity. We have shown that an orthosis "TheraTogs" (a corset with elasticated strapping) significantly increases hemiplegic muscle activity during gait. The aim of the present study is to investigate the long term effects on the recovery of gait, balance and social participation of gait rehabilitation with TheraTogs compared to gait rehabilitation with a cane following first time acute stroke.</p> <p>Methods/Design</p> <p>Multi-centre, single blind, randomised trial with 120 patients after first stroke. When subjects have reached Functional Ambulation Category 3 they will be randomly allocated into TheraTogs or cane group. TheraTogs will be applied to support hip extensor and abductor musculature according to a standardised procedure. Cane walking held at the level of the radial styloid of the sound wrist. Subjects will walk throughout the day with only the assigned walking aid. Standard therapy treatments and usual care will remain unchanged and documented. The intervention will continue for five weeks or until patients have reached Functional Ambulation category 5. Outcome measures will be assessed the day before begin of intervention, the day after completion, 3 months, 6 months and 2 years. Primary outcome: Timed "up and go" test, secondary outcomes: peak surface EMG of gluteus maximus and gluteus medius, activation patterns of hemiplegic leg musculature, temporo-spatial gait parameters, hemiplegic hip kinematics in the frontal and sagittal planes, dynamic balance, daily activity measured by accelerometry, Stroke Impact Scale. Significance levels will be 5% with 95% CI's. IntentionToTreat analyses will be performed. Descriptive statistics will be presented.</p> <p>Discussion</p> <p>This study could have significant implications for the clinical practice of gait rehabilitation after stroke, particularly the effect and appropriate use of walking aids.</p> <p>The results could be important for the development of clinical guidelines and for the socio-economic costs of post-stroke care</p> <p>Trial registration number</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01366729">NCT01366729</a>.</p

Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study

ABSTRACT: Background: Since mobility and social participation are key determinants of health and quality of life, it is important to identify factors associated with them. Although several investigations have been conducted on the neighborhood environment, mobility and social participation, there is no clear integration of the results. This study aimed to provide a comprehensive understanding regarding how the neighborhood environment is associated with mobility and social participation in older adults.Methods: A rigorous methodological scoping study framework was used to search nine databases from different fields with fifty-one keywords. Data were exhaustively analyzed, organized and synthesized according to the International Classification of Functioning, Disability and Health (ICF) by two research assistants following PRISMA guidelines, and results were validated with knowledge users.Results: The majority of the 50 selected articles report results of cross-sectional studies (29; 58 %), mainly conducted in the US (24; 48 %) or Canada (15; 30 %). Studies mostly focused on neighborhood environment associations with mobility (39; 78 %), social participation (19; 38 %), and occasionally both (11; 22 %). Neighborhood attributes considered were mainly 'Pro ducts and technology' (43; 86) and 'Services, systems and policies' (37; 74 %), but also 'Natural and human- made changes' (27; 54 %) and 'Support and relationships' (21; 42 %). Mobility and social participation were both positively associated with Proximity to resources and recreational facilities, Social support, Having a car or driver's license, Public transportation and Neighborhood security, and negatively associated with Poor user-friendliness of the walking environment and Neighborhood insecurity. Attributes of the neighborhood environment not covered by previous research on mobility and social participation mainly concerned 'Attitudes', and 'Services, systems and policies'.Conclusion: Results from this comprehensive synthesis of empirical studies on associations of the neighborhood environment with mobility and social participation will ultimately support best practices, decisions and the development of innovative inclusive public health interventions including clear guidelines for the creation of age-supportive environments. To foster mobility and social participation, these interventions must consider Proximity to resources and to recreational facilities, Social support, Transportation, Neighborhood security and User-friendliness of the walking environment. Future studies should include both mobility and social participation, and investigate how they are associated with 'Attitudes', and 'Services, systems and policies' in older adults, including disadvantaged older adults