Effects of neuromuscular electrical stimulation and core muscle strengthening on trunk instability following stroke

Background: Postural instability leads to balance dysfunction in stroke subjects, which always increase the risk of fall. This study aimed to compare the effect of neuromuscular electrical stimulation and core muscle strengthening on trunk balance following stroke.Methods: Forty five stroke subjects were participated and assigned randomly into three groups; all groups received standard rehabilitation program; and core group received additional core strengthening, neuromuscular electrical stimulation (NMES) group received added electrical stimulation over paraspinal region and combination group received core muscle strengthening and NMES along with standard rehabilitation protocol. After four weeks of the interventions, primary and secondary outcome measures are evaluated. Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale (TIS) and Barthel Index (BI) were evaluated before and after the intervention.Results: All the three (core MS, NMES and combination) groups showed significant improvement after the intervention (BBS 10.07, 15.54 and 18.27, PASS 6.54, 13.06 and 14.00, TIS 0.25, 0.25 and 0.51, BI 16.40, 29.93 and 36.53). The combination group (NMES and core muscle strengthening) showed better improvement than other two groups. TIS and BI total score showed positive (0.849) correlation.Conclusions: Addition of NMES along with core muscle strengthening for stroke rehabilitation will improve trunk stability, balance and ADLs

Incidence of tennis elbow and association of hand grip strength among college students

Background: Lateral epicondylitis is an overuse injury involving the origin of common extensor tendon at elbow joint. Among the college students there is more complaint on wrist and elbow. Objective was to find out the incidence of tennis elbow & grip strength among the students during the entire academic year.Methods: Three hundred and seventy subjects fulfilled the inclusion criteria with age respondents between seventeen to twenty four years. This study is done in those students who have local tenderness on palpation over the lateral epicondyle (grade 2). NPRS was used for measuring the pain intensity. Mill’s test and Cozen’s test was performed to confirm the tennis elbow. The subject is asked to squeeze the dynamometer three times with left and right hand respectively. There was one minute resting period between each squeeze were taken into account.Results: The incidence of confirmed tennis elbow was 4.05% & 2.70% in right and left respectively. Among those participants Mill’s test was positive in 16.2% on right and left side and Cozen’s test was positive in 8.1% on right side and 5.4% on left side. The mean rank of left and right grip strength for the students who are confirmed as tennis elbow were 52.75 Kg and 50.67 Kg and for not-confirmed were 36.56 Kg and 36.41 Kg respectively.Conclusions: The study concluded that 6.7% incidence rate of tennis elbow was observed in college students during the entire academic year. And also concluded there is no much significance correlation between grip strength and tennis elbow incidence rate

Muscle Strength in Type-2 Diabetes Mellitus and its Relationship with Biochemical Parameters and Microvascular Complications

Introduction: Sensory symptoms and deficits are frequently observed in diabetic polyneuropathy, but motor deficits are more difficult to recognise or often neglected. As a part of a rehabilitation team, we observed altered muscle strength in Type-2 Diabetes Mellitus (T2DM) in relation to neuropathy. Weakness in muscles in DM has significant effects on patient's daily living activities. Aim: To find the relationship of muscle strength in diabetes subjects characterised by microvascular complications (retinopathy, nephropathy and peripheral neuropathy associated) and biochemical measurements. Materials and Methods: The present observational study was conducted at the Department of Orthopaedics, Srinivas Institute of Medical Sciences, Mangaluru, Karnataka, India for a period of nine months from February 2020 to November 2020. Study included 72 patients divided into T2DM subjects (n=36) and non diabetic controls (n=36) with age <75 years, with a diabetic history ≥5 years. By using standard laboratory methods, biochemical measurements were taken, which included Fasting Blood Sugar (FBS) level, Glycated Haemoglobin (HbA1c), serum creatine, serum insulin, C-peptide and albumin excretion rate. The retinal status of the diabetic subjects were classified as normal, non proliferative and proliferative retinopathy, renal status classified as incipient and overt nephropathy and neuropathy as asymptomatic and symptomatic by ophthalmologist, nephrologist and neurologist respectively. Muscle strength of the upper extremities and lower extremities were measured by using hand-held dynamometer (Baseline® LiTE®). Results: Out of total 72 subjects, the mean age of diabetic and non diabetic group was 55.69±5.50 years and 55.91±5.21 years, respectively. In diabetic subjects, the median value of serum creatine was 1.04 mg/dL , FBS was 171 mg/dL, HbA1c was 9.1%,serum insulin was 24.62 mU/L, C-peptide was 1.13 ng/mL and albumin excretion rate was 57.6 mg/24 hours. Approximately, 10.5% reduction was observed at ankle dorsiflexion and plantar flexion of both sides, 7% reduction of knee extension (both side), and right knee flexion, whereas, the left knee shows a marked 10.81% reduction in muscle strength. Conclusion: Type-2 diabetes subjects have weakness of extensors and flexors of the upper and lower extremity (shoulder and hip strength not assessed in this study) with predominant reduction of muscle strength in the lower limbs