Challenges in the Diagnosis of Acute Arterial Ischemic Stroke (AIS) in Children in Saudi Arabia: Retrospective Study

Diagnosis of arterial ischemic stroke (AIS) in children is a challenge to many clinicians. Determining the time between symptom onset and diagnosis and identifying the factors that contribute to the delay in diagnosis will help target them and provide an early and effective therapeutic strategy. A retrospective study was conducted on children diagnosed with AIS admitted to Al-Yamamah Hospital, Riyadh, Saudi Arabia from January 2000 to December 2012. Data collected included the initial symptom of AIS, time from initial symptom to hospital arrival, first medical examination; initial imaging studies, and diagnosis. A total of 51 children with AIS were studied. The median pre-hospital delay (symptom onset to hospital arrival) was 10 hours (interquartile range: 2.8-13.2 hours), in-hospital delay (symptom onset to diagnosis) was 5.5 hours (interquartile range: 2.3-20.4 hours). Younger age of the patient, lower Pediatric National Institute of Health Stroke Scale score, absence of sensory-motor deficits, absence of seizures, lack of consciousness alterations, presence of heart diseases, lower response of parents to child's condition, use of private transportation, delayed referral from private clinics, length of procedures performed in the Emergency Department (ED), and lower sensitivity of CT scans are predictors of longer time to AIS diagnosis. We have identified several pre-hospital and in-hospital predictors of delayed AIS diagnosis. Managing these factors may reduce significantly the timing of diagnosis and optimize the management of children with AIS

Factors Affecting Mothers’ Adherence to Home Exercise Programs Designed for Their Children with Cerebral Palsy

Cerebral palsy is a common motor disorder that results in long-term impairment. The purpose of this study was to find out what factors influence Saudi mothers’ compliance with their Children with Cerebral Palsy (C-CP) Home Exercise Program (HEP). A self-administered online questionnaire was used to perform this qualitative research study on a group of 113 mothers who had children with CP. The study included mothers with children from birth to 12 years old who had received a HEP prescription from a physiotherapist. The measuring instrument tool was a questionnaire with two sections: demographic characteristics and a questionnaire about the parents’ adherence to the HEP. The questionnaire utilized in this study was subjected to a reliability analysis, and the derived Cronbach’s alpha was found to be 0.814 for the questionnaire (which had 17 phrases). These results imply that the questionnaire is reliable. A total of 113 responses were received, with 4 incomplete responses being eliminated. The majority of mothers (66.1%) did not follow the HEP, according to the findings of this survey. The demographics of the mothers revealed that 20–25-year-old mothers were more adherent than the other age groups. The findings of this study demonstrated that the physical therapist’s treatment of the mother influenced exercise compliance

The Relationship between Technology Use and Physical Activity among Typically-Developing Children

Objectives: This study aimed to investigate the relationship between technology use and physical activity level and to measure the association between sociodemographic characteristics of the participants, technology use, and physical activity level among Saudi children. Materials and Methods: This cross-sectional study was conducted among 458 parents of typically-developing Saudi children (6–12 years). A translated validated questionnaire used for data collection consisted of three parts: Children’s Physical Activity Questionnaire (CPAQ), Questionnaire on the Impact of Technology on Children (used to investigate the impact of technology on children’s physical activity) and sociodemographic questions (e.g, children’s age and sex, age, educational level, marital status of parents and monthly income). Data were analyzed using Pearson correlation and Mann-Whitney U test to assess the relationship between technology use and physical activity level. A chi-squared test was used to assess the relationship between technology use and sociodemographic variables. Statistical significance was set at p < 0.05. Results: Mean age of the sampled children was (8.44 ± 2.07). Data analysis revealed that high use of technology was significantly associated with low level of activity. Pearson’s correlation analysis showed a negative relationship between a high level of activity and technology use (r = −0.138, p = 0.047). Ownership of a device was significantly associated with higher technology time consumption. Regression analysis revealed that age of the child, educational level of the parents, screen time use, and owning electrical devices significantly predicted the level of practicing physical activity among children of sampled parents (p < 0.05). Conclusions: practicing inadequate physical activity among children could be influenced by educational level of parents, screen time use, and owning electrical devices. Therefore, parental involvement is required to reduce time of exposure to technology screens among children

Effect of lower limb sensory training on postural stability in stroke patients: A randomized control trial

Background: Cerebrovascular accident (Stroke) incidence is rapidly increasing and is considered to be one of the leading causes of death and physical impairment on a global level. These impairments aren’t limited to motor weakness but can also include impairments in somatosensory functions essential for producing accurate and specific motor actions. Aim of the study: To determine the efficacy of lower limb sensory training on postural stability in stroke patients. Procedures: Thirty male ambulant patients with ischemic stroke in the distribution of anterior circulation with a modified Ashworth scale not exceeding 1+. The ages of the participants were between 50-65 years. They were recruited three to six months from the onset of their symptoms. Then, they were assigned randomly into two equal groups, study group (A) and control group (B). The patients in the study group (A) have been given a combination of a sensory-based intervention program for the affected lower limb and a carefully selected physical therapy program. Control group (B) patients were treated with the same selected physical therapy program. The treatment was executed three sessions per week for six weeks. Each session was done in a 90 minutes window

Investigation of sports participation motivation in people with disabilities: a cross-sectional study of individuals with physical and hearing impairments

Abstract While reading the literature, it is seen that there are not enough studies on the motivation of disabled individuals to participate in sports. This study aims to examine the sports participation motivations of hearing impaired and physically disabled athletes. This study was a cross-sectional study. The research group of the study consists of physically and hearing-impaired individuals between the ages of 18–47. The participants of this research group consisted of 253 volunteer disabled individuals, 150 of whom were men and 103 of whom were women. Sports participation motivation scale was used for disabled individuals. The scale consists of 3 dimensions and is a 5-point Likert type. The results of the study showed that hearing-impaired people have a higher high school rate and physically person with disability have a higher bachelor’s degree rate, but the primary education rate did not change between hearing and physically person with disability. Physical activity participation differed between hearing and physically person with disability, and it was observed that hearing-impaired people participated in more physical activities. The level of well-being of the physically disabled was significantly better than the hearing impaired. As conclusion, it is observed that the people with the lowest motivation to participate in sports are primary school graduates and those with high welfare have a high motivation to participate in sports

Risk of falling in patients with unilateral discogenic sciatica

Background: Unilateral Discogenic Sciatica is low back pain radiating into one limb, in addition to one or more positive neurological signs. This pain may cause loss of function and reduce quality of life and working capability. Objective: This study was performed to assess the risk of falling in patients with unilateral discogenic sciatica. Methods: Sixty subjects participated in the study (30 patients with unilateral discogenic sciatica and 30 healthy controls). All participants undergone balance assessment using PROKIN system to evaluate static and dynamic balance. The risk of falling was evaluated via Berg Balance Scale (BBS). Results: There was significant improvement in static balance variable (sway range forward backward and mediolateral) and significant decrease in dynamic balance variable (limit of stability LOS) in the study group in comparison with the control group (P <0.05). There was substantial positive correlation between BBS score and dynamic balance (LOS) in patients with unilateral discogenic sciatica, whereas, the correlation between BBS score and static balance (sway range forward backward and mediolateral) was non-significant. Conclusion:  Sciatica affects both static as well as dynamic balance and so increases the risk of falling in patients with unilateral discogenic sciatica

Anti-gravity treadmill training for children with cerebral palsy: A systematic review and meta-analysis

Background: Walking dysfunction in children with cerebral palsy (CP) contributes to significant limitations in participating properly in daily living activities. Various types of treadmills have emerged to address this obstacle such as the antigravity treadmill (AGT) which aims towards reducing the effect of gravity on its users. Aim: This systematic review examines the literature on the effectiveness of (AGT) on walking abilities in children with CP. Methods: Protocol registration (CRD42020164202) in April 2020 was followed by six electronic database searches for randomized clinical trials (RCTs), examining the effectiveness of AGT on walking and balancing abilities in children with CP. The included studies were assessed for quality using the Physiotherapy Evidence Database (PEDro) scale. Results: Three studies of good quality met the inclusion criteria. AGT was significantly associated with improved walking velocity and cadence, while stride length showed insignificant difference between groups (SMD= 0.07, 95%CI 0.06 to 0.08, p< 0.00001),(SMD= 12.29, 95%CI 9.58 to 14.99, p< 0.00001) and (SMD= 0.07, 95%CI -0.08 to 0.23, p< 0.36).&nbsp

A Comparative Study on the Effect of Task Specific Training on Right Versus Left Chronic Stroke Patients

Functional impairment of the upper limb (UL) after stroke is a great problem. Finding methods that can improve UL function after stroke is a major concern to all medical service providers. This study was intended to compare the effect of upper limb task specific training (TST) on brain excitability of the affected hemisphere and motor function improvements in patients with left and right stroke. Forty male patients with mild impairment of UL functions were divided into two equal groups; G1 consisted of patients with left hemisphere affection (right side stroke) while G2 consisted of patients with right hemisphere affection (left side stroke). All patients received TST for the affected UL for one hour, three sessions per week for six consecutive weeks. Evaluation was performed twice, pre-, and post-treatment. Outcome measures used were Wolf Motor Function Test (WMFT) and Box and Block Test (BBT) as measures of UL motor function and Quantitative Electroencephalogram (QEEG) of motor and sensory areas of the affected hemisphere as a measure of brain reorganization post-stroke. Both groups showed improvement in motor function of the affected UL measured by WMFT and BBT with reported significant difference between them. G1 showed greater improvement in motor function of the affected UL post-treatment compared to G2. Additionally, there was a significant increase in peak frequency of motor and sensory areas with higher and significant excitability in G1 only. These findings imply that brain reorganization in the left hemisphere responded more to TST compared to the right hemisphere. Based on findings of the current study, we can recommend adding TST to the physical therapy program in stroke patients with left hemisphere lesions

The Impact of Cancer Relapse and Poor Patient Outcomes on Health Care Providers Practicing in the Oncology Field

Introduction Devastating cancer-related events are not uncommon, and these events have weakened communication performance and induced stress among health care providers (HCPs), particularly physicians. This study aimed to investigate the perspective of HCPs emotionally affected by poor clinical outcomes due to the failure of cancer therapy. Methods A cross-sectional, online survey was conducted over 3 months among HCPs practicing in the field of oncology in Saudi Arabia, comprising physicians, pharmacists, and nurses. Data were analyzed using Statistical Package for Social Sciences version 26.0. A P -value <.05 was considered statistically significant. Results This study demonstrated a positive correlation between HCPs’ length of experience and emotional impact of treatment failure, albeit this was not statistically significant (P = .071). Analysis of their perspective toward failure of cancer therapies revealed a significant impact of occupation and sex (P = .014 and P = .047, respectively). Moreover, occupation played a significant role in shaping the viewpoint of HCPs toward the need for conducing further research to test the appropriateness of treatment protocols on local patients (P = .022). Despite the emotional responses of HCPs to suboptimal clinical outcomes, factors such as work burnout, lack of concentration and patience, work or personal problems, and under appreciation were frequently identified as triggers of such outcomes. Conclusion Our results revealed that poor clinical outcomes observed among cancer patients are emotional triggers for HCPs practicing in the oncology field. The emotional response is often perceived negatively, and can potentially lead to a decline in the quality of care provided to these patients

Clinical (BMI and MRI) and Biochemical (Adiponectin, Leptin, TNF-&alpha;, and IL-6) Effects of High-Intensity Aerobic Training with High-Protein Diet in Children with Obesity Following COVID-19 Infection

Objective: To find the clinical and biochemical effects of high-intensity aerobic training with a high-protein diet in children with obesity following COVID-19 infection. Methods: By using the block randomization method, the eligible participants were randomized into two groups. The first group received high-intensity aerobic training with a high-protein diet (Group A; n = 38) and the second group were allowed to do regular physical activities and eat a regular diet (Group B; n = 38) for 8 weeks. Clinical (basal metabolic index (BMI) and muscle-mass-cross-sectional area (CSA)) and biochemical (Adiponectin, leptin, TNF-&alpha;, and IL-6) measures were measured at baseline, on the 8th week, and at 6-months follow-up. Results: Baseline demographic and clinical attributes show homogenous presentation among the study groups (p &gt; 0.05). After eight weeks of intervention, and at the end of 6-months follow-up, the basal metabolic index (BMI) (6.3) (CI 95% 4.71 to 7.88), mid-arm CSA (17) (CI 95% 14.70 to 19.29), mid-thigh CSA (13.10) (CI 95% 10.60 to 15.59), mid-calf CSA (11.3) (CI 95% 9.30 to 13.29), adiponectin (&minus;1.9) (CI 95% &minus;2.13 to &minus;1.66), leptin (5.64) (CI 95% 5.50 to 5.77), TNF-&alpha; (0.5) (CI 95% 0.42 to 0.57), and IL-6 (0.21) (CI 95% 0.18 to 0.23) showed more improvement (p &lt; 0.001) in Group A than Group B (p &gt; 0.05). Conclusion: Overall, this trial found that high-intensity aerobic training with a high-protein diet decreased the BMI percentile and muscle mass (arm, thigh, and calf), and positively altered the biochemical variables in children with obesity