Challenges & barriers for neuro rehabilitation In developing countries

People with disabilities especially neurological disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. There are not sufficient epidemiological studies from Pakistan which assess barriers to neurorehabilitation and ways to counter it

Attitude and perception of physical therapists towards multidisciplinary team aproach in stroke rehabilitation

Stroke is a long term disability in developing countries which is considered as major economic burden on part of Health care system. In developing countries multidisciplinary team approach for stroke rehabilitation is emerging in tertiary care hospitals and has considerably increased the chance of early independence, fast recovery and maximum outcome in daily activities of life. Objective: Objective of the study was to evaluate the attitude and perception of physical therapists towards multidisciplinary team approach working in stroke rehabilitation

Impact of guillain barre syndrome on psychosocial functionings of patients in islamabad

GuillainBarre Syndrome (GBS) is a rare autoimmune disease of unknown causes that affects peripheral nervous system. Objectives: To review the impacts of the GuillainBarre Syndrome on the psychosocial functioning of the patients and to assess the relationship between GuillainBarre Syndrome and the psychosocial functioning Methodology: Comparative cross sectional survey was conducted on 100 participants (50 GBS patients from Shifa International Hospitals and 50 normal participants from Islamabad in 6 months time from February to July 2013. Data collected through Structured Questionnaire in hospital settings for GBS patients and normal persons from Islamabad through Psychosocial functioning scale and social functioning scale and analyzedby using SPSS version 17

Effectiveness of stretching of the flexor retinaculum with ultrasonic therapy in the management of carpal tunnel syndrome

Aims & Objective: The objective of study was to compare the effectiveness of manual stretching of the flexor retinaculum with or without ultrasonic therapy. Methods: The study was started by selecting the 50 patients from the out patients department of Al-nafees Hospital AlipurFarash and National institute of Rehabilitation Medicine Islamabad with history of carpal tunnel syndrome. The 25 patients in experimental group were treated with manual stretching of flexor retinaculum and ultrasound and 25 patients of control group were treated with manual stretching of flexor retinaculum. Every session was started by assessment of improvement of the symptoms in each patient. Data was collected through Numeric pain rating scale, point Paresthesia assessment scale and muscle strength by hydraulic hand dynamometer. Independent sample t-test was used to analyze the data with p ≤ 0.05. Results: The mean age of subjects was 1.78±0.64 and 41 subjects have CTS of Right hand remaining 9 subjects were left handed. After the completion of the treatment program it was observe that there was no difference in the effectiveness of manual Stretching of flexor retinaculum with ultra sound therapy and manual stretching of flexor retinaculum alone. The NPRS, paresthesia and muscle stretch showed p≥0.05 between experimental and control groups. Conclusion: This study proved that manual stretching of the flexor retinaculum along with ultra sonic therapy have same affects as manual stretching of the flexor retinaculum alone

Translation and cultural adaptation of Shoulder Pain and Disability Index in Urdu (SPADI-U)

Introduction: Shoulder joint is the third most-frequently involved structure in musculoskeletal conditions globally. More than 30 shoulder specific questionnaires have been generated in English in order to measure shoulder related quality of life and incidence of pain. Among all these questionnaires, Shoulder Pain and Disability Index (SPADI) is one of the most useful tools, therefore it has been translated, culturally adapted and validated to many languages. This study was carried out to translate and culturally adapt SPADI into Urdu language. Material & Methods: Study was conducted over a timeframe of three months, that’s March 2019 to May 2019 in Helping Hand Institute of Rehabilitation Sciences, Mansehra. Translation and cultural adaptation of Shoulder Pain and Disability Index (SPADI) was carried out according to internationally published six-step guidelines. In accordance with the provided directions a number of changes were made to the six-step guidelines. Through consensus of the expert panel, its final version was field in and tested on forty individuals with and without shoulder pathologies in an equal proportion. Results: Changes were required during each step of Beaton’s guidelines for cross-cultural adaptation. Translators during ‘forward and backward translations’ had faced a number of obstacles. Minor differences were found during reconciliation process and expert panel review. The pilot testing highlighted, misinterpretation among target population regarding item 3, 5, 7 and 8 of disability scale due to cultural differences. These items were adjusted according to cultural relevance and conceptual equivalence to the original version. Final version was found relevant and easily understood by the patients having shoulder pathology. Conclusion: SPADI-U has good face and content validity and it can be used to measure shoulder related quality of life in Urdu speaking population

Neurorehabilitation in time of COVID 19: a perspective from Pakistan

A global public health emergency, the coronovirus disease-2019 pandemic has impacted every way of life, including neuro-rehabilitation, worldwide. Issues related to increased service demand in primary care, exhausted or insufficient healthcare facilities were significantly high in low and middle-income countries, like Pakistan, with already a struggling health infrastructure. This required major change in health service delivery and impacted rehabilitation care of vulnerable patients with neurological conditions and impairments. For the current review, relevant key words and their combinations were used for literature search, including ‘COVID 19’, ‘SARS-CoV-2’, ‘Corona Virus’, ‘rehabilitation’, ‘physical rehabilitation’, ‘pandemic’, ‘NCOC’, ‘lockdown’, ‘health services’, ‘physical therapy’, ‘disability’, ‘access’, ‘tele-rehabilitation’, ‘research’, ‘human resource’, ‘healthcare’, etc. The platforms searched were Google search, Google Scholar and PubMed. The idea was to highlight how the pandemic impacted neuro-rehabilitation care in countries like Pakistan throughout the pandemic duration and during the lockdowns. Key Words: COVID 19, Disability, Health services, Neuro rehabilitation, Pakistan

Effects of high-intensity multi-modal exercise training (HIT-MMEX) on bone mineral density and muscle performance in postmenopausal women. A Pilot randomized controlled trial

Objectives: To determine the effects of high-intensity multimodal exercise training on bone mineral density and muscle performance in postmenopausal women. Method: The two-armed, parallel, pilot randomised controlled trial was conducted from November 2020 to July 2021 at Riphah Rehabilitation Centre, Rawalpindi, Pakistan, and comprised women aged 45-70 having been in the post-menopause phase for at least 3 years, with body mass index <30, community ambulant and willing to have exercise therapy. The subjects were randomised into two equal groups. The experimental group A received supervised high-intensity resistance, weight-bearing, balance and mobility training twice weekly for 8 months. The control group B received low-to–moderate intensity exercises. Femoral neck and lumbar spine bone mineral density (g/cm2) were taken through a dual-energy X-ray absorptiometry scan. Muscle performance was measured using 1 repetition maximum for leg and trunk extensors, and 30 sec sit to stand test. Data was analysed using SPSS 21. Results: Of the 101 women screened, 28(27.7%) were enrolled; 14(50%) in group A having mean age 53.36±6.28 years, and 14(50%) in group B having mean age 51.71±4.82 years (p>0.05). Group A showed significantly more improvement than group B both with respect to lumbar spine bone mineral density and muscle performance (p<0.05). Conclusion: Supervised high-intensity multimodal exercise training protocol had a positive effect on lumbar spine bone mineral density and muscle performance in postmenopausal women. Clinical Trial Number: NCT04653350 Link https://clinicaltrials.gov/ct2/show/NCT04653350 Key Words: Osteoporosis, Post-menopausal, Bone density, Strength, Muscle

Walking related performance fatigability in persons with knee osteoarthritis; an important yet neglected outcome

Published in May - 202

The Role of Speech-language Pathologists in the Hospitals of Pakistan

Objectives: This study aimed to assess the knowledge and perception of the role of speech therapists by other medical professionals in public hospitals. Methods: This cross-sectional study recruited 200 healthcare professionals with >1year of job experience at the workplace of both genders and any age. Besides, the study subjects were selected using a non-probability convenience sampling approach. The study sample was recruited from 25 District and Tehsil Headquarter Hospitals from April 1, 2019, to September 30, 2019. A basic demographic datasheet and the Knowledge, Attitude, and Practices (KAP) survey were used for data collection. Statistical analysis was performed in SPSS. Results: Out of the total 200 eligible professionals from different departments, the Mean±SD scores of the responses were highest (75.14±24.87) in pediatric medical professionals. Moreover, the lowest scores (46.70±0.01) concerned Intensive Care Unit (ICU) experts; this difference was statistically significant (P<0.001). Similarly, a significantly higher Mean±SD score of 74.05±20.04 was noted for those working day shifts, compared to that of (35.01±8.52) those working in night shifts (P<0.001). Discussion: The knowledge and perception of different healthcare professionals serving in public hospitals vary regarding the role of SLPs. Such differences concern their profession, with pediatrics presenting the highest level of understanding, followed by general medicine. However, psychiatry and ENT professional provided the least understanding in this area. The professionals working in day shifts suggested better knowledge and perception, compared to night shifts staff

The UN Incheon strategy Implementation and the Pakistani quagmire; ground realities

Abstract “Economic and Social Commission for Asia and the Pacific” (ESCAP) is the regional developmental arm of “United Nations” (UN). There are over 650 million persons with disabilities (PWDs) living in the region. In 2012, the members of the ESCAP, including Pakistan gathered and launched the new decade of PWDs from 2013 to 2022 adopting the Incheon Strategy to “Make the Right Real” for PWDs, which is based on the “Convention on the rights of Persons with Disabilities” (CRPD) and aims to accelerate the disability inclusive development with 10 measurable time-bound goals and targets. The year 2017 marked the mid-point of the decade, and a “Government Members Report on the Implementation of Incheon Strategy” was submitted to UN-ESCAP by the member countries