PROBLEM ORIENTED WILLED MOVEMENT THERAPY ON MOTOR ABILITIES OF TRAUMATIC BRAIN INJURY PATIENTS WITH COGNITIVE DEFICITS

Background: Falls are a major problem in the elderly leading to increased morbidity and mortality in this population. Scores from objective clinical measures of balance have frequently been associated with falls in older adults. The Berg Balance Score (BBS) which is a frequently used scale to test balance impairments in the elderly ,takes time to perform and has been found to have scoring inconsistencies. The purpose was to determine if individual items or a group of BBS items would have better accuracy than the total BBS in classifying community dwelling elderly individuals according to fall history. Method: 60 community dwelling elderly individuals were chosen based on a history of falls in this cross sectional study. Each BBS item was dichotomized at three points along the scoring scale of 0 – 4: between scores of 1 and 2, 2 and 3, and 3 and 4. Sensitivity (Sn), specificity (Sp), and positive (+LR) and negative (-LR) likelihood ratios were calculated for all items for each scoring dichotomy based on their accuracy in classifying subjects with a history of multiple falls. These findings were compared with the total BBS score where the cut-off score was derived from receiver operating characteristic curve analysis. Results: On analysing a combination of BBS items, B9 and B11 were found to have the best sensitivity and specificity when considered together. However the area under the curve of these items was 0.799 which did not match that of the total score (AUC= 0.837). A, combination of 4 BBS items - B9 B11 B12 and B13 also had good Sn and Sp but the AUC was 0.815. The combination with the AUC closest to that of the total score was a combination items B11 and B13. (AUC= 0.824). hence these two items can be used as the best predictor of falls with a cut off of 6.5 The ROC curve of the Total Berg balance Scale scores revealed a cut off score of 48.5. Conclusion: This study showed that combination of items B11 and B13 may be best predictors of falls in the elderly with a cut off of 6.5

MULLIGAN MOBILIZATION VERSUS STRETCHING ON THE MANAGEMENT OF PIRIFORMIS SYNDROME A COMPARATIVE STUDY

Background: Piriformis syndrome is a commonly overlooked specific cause of low back pain. Apart from mimicking the sciatica-like symptoms, unilateral piriformis tightness can cause rotational dysfunction and pain in the lumbar region. This could lead to low back pain which is a common musculo skeletal problem and a major reason for activity limitation. Stretching the piriformis tightened muscle is a preferred choice of treatment against surgical intervention to release the muscle. Mulligan’s mobilization is based on movement with mobilization which is proven to be effective in many musculo skeletal dysfunctions including the lumbar spine. The purpose of this study is to explore and compare the two treatment methods in relieving the low back pain in clinical conditions with piriformis syndrome. Methods: In this experimental study, 40 patients with piriformis syndrome were selected and divided into two groups. One group was given only piriformis stretching for the tightened muscle and the other group given Mulligan mobilization for lumbo sacral joints. VAS and lower limb functional index were taken to compare before and after the treatment regime of 4 weeks. Results: There was no significant difference between the two groups in both pain scale and lower limb mobility and function. But there was significant improvement in pain relief and LLFI after the treatment regime in both groups compared to the pre-treatment status. Conclusion: Even as the piriformis syndrome is caused by the tightness of the muscle, the consequence in the lower back and lumbar spine mobility can be improved by a Mulligan mobilization as a single mode of intervention . Keywords: piriformis syndrome, lower limb functional scale, low back pain, Mulligan’s mobilizatio

EFFECTIVENESS OF A NEW BALANCE TRAINING PROGRAM ON ROCKER BOARD IN SITTING IN STROKE SUBJECTS A PILOT STUDY

Background: Stroke has been considered to be the most common cause of neurological disability with very high prevalence rate. The recovery of independence following stroke is a complex process requiring the reacquisition of many skills. Since controlling the body’s position in space is essential part of functional skills, restoration of balance is a critical part of the recovery of ability after stroke. Most of the work done regarding balance training in stroke subjects has focused on task-oriented activities and training under varied sensory input and found them to be effective. Studies have also compared the effect of stable and unstable surfaces on balance in stroke subjects and found that balance training on unstable surfaces is more effective in improving static and dynamic balance. There has not been any study till date investigating the effectiveness of balance training program on rocker board which is specific for stroke subjects who have difficulty in standing. Since balance training on rocker board in sitting has proved to be effective in improving balance in subjects with spinal cord injury who have difficulty in standing, there is a need to find out if similar balance training program on rocker board in sitting is also effective for improving balance of stroke subjects. Method: A Pilot study was performed on 10 stroke subjects selected through purposive sampling. Subjects were divided into two groups by randomization as control (CG) and experimental group (EG). EG received balance training on a rocker board along with conventional physiotherapy program. The CG received only conventional physiotherapy program. Results: Post-intervention Berg balance scale score of EG and the CG was statistically significant (p < 0.05) in both the groups as compared to pre-treatment depicted through Wilcoxon signed rank analysis within the groups. Greater improvement was observed in the EG compared to the CG post-treatment, analysed through Mann-Whitney U test with statistically significant results (p < 0.05). Conclusion: The new balance training program on rocker board in sitting is effective for improving balance of stroke subjects

MULLIGAN MOBILIZATION VERSUS STRETCHING ON THE MANAGEMENT OF PIRIFORMIS SYNDROME A COMPARATIVE STUDY

Background: Piriformis syndrome is a commonly overlooked specific cause of low back pain. Apart from mimicking the sciatica-like symptoms, unilateral piriformis tightness can cause rotational dysfunction and pain in the lumbar region. This could lead to low back pain which is a common musculo skeletal problem and a major reason for activity limitation. Stretching the piriformis tightened muscle is a preferred choice of treatment against surgical intervention to release the muscle. Mulligan’s mobilization is based on movement with mobilization which is proven to be effective in many musculo skeletal dysfunctions including the lumbar spine. The purpose of this study is to explore and compare the two treatment methods in relieving the low back pain in clinical conditions with piriformis syndrome. Methods: In this experimental study, 40 patients with piriformis syndrome were selected and divided into two groups. One group was given only piriformis stretching for the tightened muscle and the other group given Mulligan mobilization for lumbo sacral joints. VAS and lower limb functional index were taken to compare before and after the treatment regime of 4 weeks. Results: There was no significant difference between the two groups in both pain scale and lower limb mobility and function. But there was significant improvement in pain relief and LLFI after the treatment regime in both groups compared to the pre-treatment status. Conclusion: Even as the piriformis syndrome is caused by the tightness of the muscle, the consequence in the lower back and lumbar spine mobility can be improved by a Mulligan mobilization as a single mode of intervention

ANTAGONIST VERSUS AGONIST MUSCLE NEUROMUSCULAR ELECTRICAL STIMULATION ON SPASTICITY IN STROKE PATIENTS

Background: Spasticity is the common problem encountered in the treatment of hemiplegic patients. Various treatment techniques have been developed to reduce spasticity, neuromuscular electrical stimulation is one of them. Several studies have proved that stimulation of either spastic muscle or stimulation of antagonist muscle to spastic muscle results in a reduction of spasticity. However, there is no literature available on a comparative study to suggest which method is more effective in spasticity reduction. Hence this study was undertaken to find out the efficacy of each technique and to compare the two techniques of Neuromuscular electrical stimulation to determine the most effective technique. Methods: In this study with pre and post-experimental design 30 post-stroke patients were selected and they were randomly assigned into two groups. Group A received anatagonist (triceps) muscle Neuromuscular electrical stimulation and Group B received agonist (biceps brachii) muscle Neuromuscular electrical stimulation for 2 weeks, one session per day for a duration of 30 minutes. Outcome measures were recorded using modified Ashworth scale and deep tendon reflex grading scale. Results: Statistical analysis was carried out by using Wilcoxon signed rank sum test and Mann-Whitney U test at 0.05 level of significance. There was a significant recovery after the treatment based on the Modified Ashworth Scale and deep tendon reflex grading scale scores before and after the intervention within the groups and between the groups with p-value< 0.001. The group receiving the antagonist muscle neuromuscular electrical stimulation showed better recovery with a mean difference of 1.8 and 1.2 on Modified Ashworth Scale and reflex grading scale respectively. Conclusion: The study concluded that both the techniques resulted in reduction of spasticity and on comparison it was found that antagonist muscle (triceps) Neuromuscular electrical stimulation reduced spasticity more effectively than the agonist muscleNeuromuscular electrical stimulatio

INTRA-RATER RELIABILITY OF WII BALANCE BOARD (WBB) IN ASSESSING STANDING BALANCE IN OLDER ADULTS

Background: WII Balance Board (WBB) being one of the latest, advanced technologies of high sensitivity in monitoring change in balance over time and owing to, ease of use, and portability, it is being used in physical therapy clinics as a popular substitute for the expensive and complicated force plates to improve dynamic strength and balance. Despite its growing popularity, the WBB’s reliability as an intervention and assessment tool for balance is still being investigated. So this study aims in finding the accuracy of WBB. The objectives of the study are to find the Intraclass Correlation Coefficient and Standard Error Measurement on both day 1 and day 2 with eyes closed and eyes open in older adults. Method: 30 subjects over the age of 65 years were assessed for balance using WBB. Subjects were measured in double limb stance with eyes open and closed with feet comfortably distant apart on the board. The same procedure was repeated after 24 hours. Results: The study showed to be statistically significant for eyes open on day 1 and day 2, but was not statistically significant for eyes closed on day 1 and day 2. Conclusion: The study suggested that the WBB was reliable for eyes open and not reliable with eyes closed

SENSITIVITY AND SPECIFICITY OF INDIVIDUAL BERG BALANCE ITEMS COMPARED WITH THE TOTAL SCORE TO PREDICT FALLS IN COMMUNITY DWELLING ELDERLY INDIVIDUALS

Background: Falls are a major problem in the elderly leading to increased morbidity and mortality in this population. Scores from objective clinical measures of balance have frequently been associated with falls in older adults. The Berg Balance Score (BBS) which is a frequently used scale to test balance impairments in the elderly ,takes time to perform and has been found to have scoring inconsistencies. The purpose was to determine if individual items or a group of BBS items would have better accuracy than the total BBS in classifying community dwelling elderly individuals according to fall history. Method: 60 community dwelling elderly individuals were chosen based on a history of falls in this cross sectional study. Each BBS item was dichotomized at three points along the scoring scale of 0 – 4: between scores of 1 and 2, 2 and 3, and 3 and 4. Sensitivity (Sn), specificity (Sp), and positive (+LR) and negative (-LR) likelihood ratios were calculated for all items for each scoring dichotomy based on their accuracy in classifying subjects with a history of multiple falls. These findings were compared with the total BBS score where the cut-off score was derived from receiver operating characteristic curve analysis. Results: On analysing a combination of BBS items, B9 and B11 were found to have the best sensitivity and specificity when considered together. However the area under the curve of these items was 0.799 which did not match that of the total score (AUC= 0.837). A, combination of 4 BBS items - B9 B11 B12 and B13 also had good Sn and Sp but the AUC was 0.815. The combination with the AUC closest to that of the total score was a combination items B11 and B13. (AUC= 0.824). hence these two items can be used as the best predictor of falls with a cut off of 6.5 The ROC curve of the Total Berg balance Scale scores revealed a cut off score of 48.5. Conclusion: This study showed that combination of items B11 and B13 may be best predictors of falls in the elderly with a cut off of 6.5