Pakistan Journal of Rehabilitation

COLLABORATIVE TEAM IN THE MANAGEMENT OF DYSPHAGIA

Hafeez Punjwani — 2023-01-05

Dear Editor,

Swallowing is an essential requirement for life. Eating is not only a practical act (i.e., obtaining the nutrition necessary for survival) but also involves social interaction. Having meals with family and friends is almost universally necessary for personal interactions¹. Dysphagia is derived from the Greek Language "Dys" which means “difficulty or dysfunction" and "Phagia" means "to eat". However, it is defined as difficulty in processing or swallowing food from mouth to stomach².

UNVEILING THE LANDSCAPE: NETWORK ANALYSIS IN PAKISTAN'S ACADEMIC REALM

Ali Farhad — 2023-01-05

Network analysis has played a pivotal role in shaping the academic landscape in an era characterized by connectivity and information sharing. Pakistan is at the intersection of this technological revolution with a strong academic heritage and a growing desire for knowledge. The goal of the editorial piece "Unveiling the Landscape: Network Analysis in Pakistan's Academic Realm" is to highlight the increasing importance of network analysis in Pakistani academia and the ways in which it is changing the production, utilization, and dissemination of knowledge.

INVESTIGATING THE BINGE-WATCHING BEHAVIOR ON INSOMNIA AND OBESITY AMONG GENERATION Z

Aniqa Saeed — 2024-01-05

Background and Aims: The study identified the risks of increased screen time on generation z considering two parameters i.e., insomnia and obesity and the moderating role of self-control.

Methodology: A cross-sectional study was conducted by convenient sampling technique. The survey only included people who were born between 1997 and 2002. The analysis of the effects of variables took into account only a few parameters. Discriminant validity and convergent validity was used to check reliability and validity while path coefficient analyzed the hypothesis.

Results: Binge-watching has positive significant impact on insomnia and obesity (p<0.05), and the self-control strongly effect the relationship of binge-watching, obesity and insomnia as a moderator (p<0.05).

Conclusion: Binge-watching caused insomnia and obesity while self-control in direct relation to obesity and insomnia controlled the prevalence rate. The moderating role of self-control showed that insufficiency of self-control during binge-watching led to obesity and insomnia. The outcome indicated that Generation Z needs to be encouraged to practice self-control through public health initiatives, social media, seminars, workshops, etc. At the same time, people need to be made aware of how binge-watching affects their health.

Keywords: Insomnia, obesity, self-control, screen time, technology, mortality, exercise.

EFFECTS OF CRANIOCERVICAL FLEXION EXERCISES AND SCAPULAR STABILIZATION EXERCISES IN NECK PAIN AND FORWARD HEAD POSTURE AMONG FEMALES WEARING HEADSCARVES

Sanjeela Abbas — 2024-01-05

Background: In neck related problems, limited cervical ranges are considered a major contributor leading to forward head posture and increased disability.

Methodology: The study design was a randomized clinical trial. Total of 50 subjects were recruited that fulfilled the selection criteria. Subjects were divided into two groups. Craniocervical flexion exercises group A (n=25) and Scapular stabilization exercises group B (n=25). Numeric Pain Rating Scale (NPRS) and Neck Disability Index (ND1) were subjective while the goniometer and plumb line were used as objective modes of assessment. Baseline and after 4 weeks of treatment values were assessed by using SPSS 21.

Results: Both groups showed improvement in plumb line values, forward head posture and cervical spine mobility. NPRS, and NDI score values after the 4-week exercise program showed significant results (p-value<0.05). Outcomes except for plumb line value and NDI score indicated statistically significant improvement in the Craniocervical flexion exercise group than the scapular stabilization exercise group (p-value<0.05). However, in NPRS no statistical difference (p-value>0.05) was found between the two groups.

Conclusion: Only females were recruited. Further studies can correlate with spatiotemporal features. The idea and conceptual framework were original.

GENDER DIFFERENCE IN FUNCTIONAL DISABILITY AMONG PATIENT WITH NON-SPECIFIC CHRONIC LOW BACK PAIN

Fareeha Amjad — 2024-01-05

Background of the Study: LBP is a common condition that can be specific or non-specific. Non-specific LBP, which has no known cause, is responsible for 90% of cases and causes pain in the back from the 12th rib to the inferior gluteal folds.

Methodology: The study utilized a cross-sectional design in which both males and females completed the Oswestry low back questionnaire. The data was entered and analyzed using SPSS version 21.

Results: 85 patients participated in the study with a mean age of 38±9.603. Pain levels varied among patients, with 23 reporting no pain, 29 with light pain, 23 with moderate pain, and 10 with pretty severe pain. Patients had varying degrees of self-care ability with 13 able to care for themselves without triggering pain and 4 requiring daily assistance. Most patients (75 out of 85) had minor disabilities, while 10 had moderate disabilities. The relationship between the ODI score and the question was found to be similar.

Conclusion: The data suggest that individuals with non-specific chronic low back pain have only a limited impairment, and only a few suffer from moderate sickness that affects their social lives. Non-specific persistent low back pain is not connected with gender differences in functional impairment.

COMPARISON OF PATELLAR MOBILIZATION AND TAPING IN PATIENT WITH PATELLOFEMORAL PAIN SYNDROME

Rabia khan — 2024-01-05

Background of the Study: To compare patellar taping and mobilization plus conventional therapy for reducing knee pain in patients with patellofemoral pain syndrome (PFPS).

Methodology: Controlled trial with 50 participants divided into two groups who received different treatments for 6 weeks: Group A had patellar taping and iliotibial band stretching, while Group B had patellar mobilization and quadriceps strengthening. Participants received three treatment sessions weekly for six weeks. The VAS was used to conduct pre and post-test pain evaluations for groups A and B.

Results: Knee pain decreased in PFPS patients receiving patellar taping (Group A) or mobilization (Group B) using VAS (p<0.05). All treatments are effective for PFPS. The VAS scores after 6 weeks of post A and post B treatments assessed. After 6 weeks of taping, mean = 0.76±0.83. After 6 weeks, mean and SD = 1.20±1.12 from patellar mobilization. No significant difference between means (p = 0.12, α ≤ 0.05). Insignificance.

Conclusion: The result of the study indicated that after 6 weeks of treatment for both patellar taping and patellar mobilization were effective in decreasing pain in PFPS.

EFFECTS OF CERVICAL MUSCLES STRENGTHENING WITH AND WITHOUT SHOULDER EXERCISES IN POST-MASTECTOMY PATIENTS WITH NECK PAIN

Nimra Basit — 2024-01-05

Background of the Study: To compare the effects of cervical muscles strengthening with and without shoulder exercises on post- mastectomy patients with neck pain.

Methodology: It was a randomized clinical trial, conducted in physical therapy department of a clinical setting through Dynamometer. Sample size of 24 patients were taken. Non-probability convenience sampling technique was used. A written consent form was taken from patients meeting inclusion criteria and were randomly allocated. In one group, patients were treated with cervical Muscles strengthening with shoulder exercises. In other group, patients were treated with cervical Muscles strengthening alone. Treatment was given once a day for three weeks. Muscle strength was examined using dynamometer, Baseline data was taken before treatment on first day after inclusion in study and again on the last day after treatment. SPSS 25 was used to analyze the data.

Results: Wilcoxon signed rank test was used to compare individuals within the group which showed significant results in both groups, p-value 0.000 (i.e. <0.001) for neck strength. Between groups comparison was done using Mann-Whitney U Test and it showed no significant changes for cervical extensors (p- value;0.143) , cervical side bending (right) (p-value; 0.315) and cervical side bending (left) (p-value; 0.853) strength differences, but however cervical flexors strength showed statistically significant results as p-value was 0.003.

Conclusion: It was concluded that Cervical strengthening along with shoulder Rehabilitation can help improve the strength of cervical flexors. However, both the groups have equally resulted in improved cervical extensor, Side bending right and left strength.

FUNCTIONAL OUTCOME AMONG PATIENTS WITH ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH ENDO-BUTTON AT GHURKI TRUST TEACHING HOSPITAL POST 6 MONTHS-A SINGLE CENTERED SURVEY

Maria Abdul Karim — 2024-01-05

Background of the Study: To assess the functional outcome among patients with arthroscopic ACL reconstruction with endo-button at Ghurki Trust Teaching Hospital post 6 months.

Methodology: A single centered survey was conducted on 67 patients with arthroscopic AC Ligament reconstruction using Hamstring auto-graft (Semitendinosus-Gracilis tendons) after 6 months and evaluated for functional outcome. The data was collected from Ghurki Trust Teaching Hospital. The sampling procedure utilized was non-probability sampling. Functional outcome was assessed using subjective form of IKDC score. Data was analyzed using SPSS version 23.

Results: Out of 67 patients, all were male. The pre-operative subjective IKDC scoring was less than 30 and post-operative mean IKDC scoring is 73.92. On the basis of findings of study, significant improvement was observed after ACL reconstruction post 6 months.

Conclusion: ACL reconstruction shows significant improvement in knee function and significant recovery of preoperative functional status.

OCCURRENCE OF LOWER EXTREMITY MUSCULOSKELETAL INJURIES DURING THE LOCKDOWN IN ATHLETES

Ghazal Azhar — 2024-01-05

Background of the Study: Lockdown was implemented worldwide to limit the spread of COVID-19. This sudden implementation of lockdown causes significant lifestyle changes for every individual. Along with the general population, it also has psychological, behavioral, and physical consequences on athletes. The study objective is to determine the occurrence of lower extremity musculoskeletal injuries during the COVID-19 lockdown in athletes.

Methodology: Retrospective cross-sectional study design was used, and participants were recruited by a non-probability convenient sampling technique. A sample size of 147 was taken as calculated by the Raosoft software, and the study was completed 6 months. Both male and female athletes between the age group of 18-35 years, participants who did not participate in any official training session during the lockdown and registered at domestic level for at least 2 years were recruited from Pakistan Sports Board and Wapda Sports Complex Lahore. Data was collected using a semi-structured questionnaire. Nordic Musculoskeletal Questionnaire was used to identify the problematic painful areas of body. Data entry, analysis, and interpretation were done by using SPSS software version 22.0.

Results: The mean age and BMI of participants were 25.6531±4.49 (years) and 23.28±3.24 (kg/m2) respectively. From the total, 39.5% of participants reported lower extremity musculoskeletal injuries. And most reported problematic areas include lower back and knee. 75% of participants continue to do workouts at home as a prevention strategy against injury occurrence.

Conclusion: This concluded that the occurrence of lower extremity musculoskeletal injuries during the lockdown was moderate.

SMART FOOT INSOLE FOR REDUCING THE RISK OF FOOT ULCERS IN DIABETIC PATIENTS BY MEASURING PLANTAR PRESSURE

Mehwish Faiz — 2024-01-05

Background of the Study: The prevailing cause of Diabetes is a decline in insulin production, the outcome of which is an elevated glucose level in the blood. The superabundance of glucose in the blood can cause severe complications, damaging other body organs, including kidneys, nerves, heart, and upper and lower limbs. However, the common complication in diabetic patients is foot ulcer, which is directly associated with Diabetic peripheral neuropathy (DPN), which is the extensive cause of this. DPN is the inability of nerves to sense any external change, due to which the foot plantar pressure is altered and evolves because of the high glucose level.

Methodology: This paper provides a solution in the form of a portable and cost-effective device based on force sensors for diabetic patients to monitor the change in foot plantar pressure at home and overcome the risk of foot ulceration. The device is implemented on 30 participants to characterize the plantar pressure values with flat foot and normal foot types for the Control group and diabetic group.

Results: An evident difference in the value of Mid-foot pressure is observed for both the groups, Control group (Normal foot = 144+2.63 kPa, Flat foot = 150+2.72 kPa) and Diabetic Group (Normal foot = 213+2 kPa, Flat foot = 216+1 kPa). Deviation in these values discriminates the mid-foot pressure for the two groups, thus providing us a range for the individuals of the control group for the alarming situation.

Conclusion: Noticing the plantar pressure through the proposed device helps diabetes patients reduce their risk.

EFFECTS OF MULLIGAN ROTATIONAL MOVEMENT VERSUS MEDIAL GAPPING TECHNIQUE ON PAIN, RANGE OF MOTION AND DISABILITY IN PATIENTS WITH KNEE OSTEOARTHRITIS

Hina Gul — 2024-01-05

Background and Aim: To compare the effects of mulligan rotational movement and medial gapping technique on pain, range of motion and disability in knee osteoarthritis patients.

Methodology: This study was a Randomized Clinical Trial. The data was collected using a convenience sampling technique. Data was collected from Jinnah Hospital Lahore, from 15th December – 30th June 2022.36 subjects (males and females) were recruited in two groups. The first group received Mobilization with movement along with a conservative treatment protocol. The second group received the Medial gapping technique along with conservative treatment protocol. Each group was treated for four weeks in which three sessions per week were given. Numeric pain rating scale and the disability index were used as outcome measures. Data was analyzed through statistical package for the social sciences (SPSS) version 25.

Results: Within-group comparison by paired t-test showed the p-value was significant <.05, indicating that both treatment was effective in improving symptoms. Between groups, comparison by independent t-test showed that Mulligan Mobilization Technique is more effective than the medial gapping technique in improving pain disability and quality of life.

Conclusion: The study concluded that Mulligan Mobilization Technique provides more clinical benefits regarding pain, disability and range of motion in osteoarthritis patients than Medial Gapping Technique.

ASSESSMENT PRACTICES OF SPEECH AND LANGUAGE PATHOLOGISTS FOR COGNITIVE COMMUNICATION IMPAIRMENT AFTER TRAUMATIC BRAIN INJURY

Umarah Khadim — 2024-01-05

Background of the Study: The aim of the present research was to examine the assessment practices of Speech-Language Pathologists for Cognitive Communication Disorders after Traumatic Brain Injury.

Methodology: It was a cross-sectional survey method, a convenient sampling technique. Research was carried out from January 2021 to June 2021. The sample size was n=21, out of which n= 9 (42.8%) participants, each from Rawalpindi and Islamabad n= 3 (14.4%) participants from Lahore filled in their responses. Medium; being Online, the questionnaire was distributed either through email, WhatsApp or Facebook MessengerApp. SLPs who were undergraduates or who had no experience working with TBI clients were excluded. Questionnaire included 12 items. Responses of research participants were recorded using Google Forms and presented in the form of n (%). The data were analyzed using descriptive analysis, and chi-square analysis was performed to confirm the association between settings, city of practice and years of experience through Statistical Package of Social Sciences (SPSS) Version 22.0.

Results: Speech-Language Pathologists reported that they routinely assessed (62% each) Receptive and Expressive communication. However; less than half of the participants routinely evaluated domains like verbal pragmatic skills (43.3%), functional communication (33.3%) and phonemic awareness (33.3%). SLPs assessed their clients by employing tests like MoCA (55.62%), Quick Aphasia Battery (18.75%), Cognitive Assessment (LOTCA Protocol) (14.35%) and a combination of Formal (48%) and Informal (52%) clinical interviews.

Conclusion: Informal discourse assessment is incorporated more frequently as compared to informal discourse evaluation in assessment practices of Speech-Language pathologists of Pakistan for cognitive communication impairment followed by traumatic brain injury.

MEASURE THE LEVEL OF SENSORY PROCESSING PROBLEM IN CHILDREN WITH AND WITH OUT AUTISM IN CLASSROOM ENVIRONMENT

Nighat Tahir — 2024-01-05

Background of the Study: Sensory processing is the process in which all sensory stimuli integrate and enable person to respond according to the situation. There are number of sensory issues that either parents or teacher do not identify on early stages and various times it also cause behavioral issues or academic issues with in typical children too. The study aims to assess the sensory vulnerability of children with and without autism in the school environment and to identify the sensory issues.

Methodology: This was a cross-sectional study conducted in Karachi, Pakistan. Total 86 children recruited and divided into two groups included typical and atypical children. Using a standardized questionnaire-SPM (sensory processing measure) distributed in schools and completed by teachers.

Result: Autism affects both mainstream children and children with autism, with sensory process subscales showing significant differences p value (< .005) for t- test. Autism children have higher sensory process vulnerability, particularly in social participation and praxis variables, compared to mainstream children’s.

Conclusion: The study reveals that school initiates sensory stimuli, affecting children's vulnerability, even in special schools, despite providing structured environments for atypical children.

FREQUENCY OF TIBIA VARA AMONG OBESE ADOLESCENTS: DESCRIPTIVE CROSS-SECTIONAL STUDY

Nadiyya Hamid — 2024-01-05

Background of the study: Tibia Vara is defined as a growth abnormality which leads to Varus malalignment of the lower limb. It is caused by excessive loading on the medial part of proximal tibia. Progressive Tibia Vara can result in a bowleg deformity which is most noticeable in posteromedial part of upper tibial physis. Other than that, it gives rise to in toeing of feet and lateral knee thrust, altering the normal biomechanics of an individual. This study aim to determine the frequency of Tibia Vara among obese adolescents (13-18years).

Methodology: A descriptive cross-sectional study was done using non probability convenient sampling. Total 214 obese adolescents of age range 13 to 18 years were recruited from different parks and schools of Lahore. Adolescents with BMI less than 30 and with history of fracture or dislocation in the lower limb were excluded from the study. Manual goniometer was used to assess tibia vara in obese adolescent which had an intra-rater reliability of 0.75.

Results: Out of 214 obese adolescents, 128 were male and 86 were female. The percentage of Tibia Vara in this population was found to be 38% (n= 82). Whereas; on the basis of gender, male participants presenting with Tibia vara was found to be 26% (n= 56) and the percentage of females reported with Tibia vara was only 12% (n= 26).

Conclusion: Tibia vara had been reported in 38% of the obese adolescents in Lahore, Pakistan. Whereas, on the basis of gender most frequently tibia vara was reported among male participants.

EFFECTS OF RELAXING MUSIC THERAPY ALONG WITH TASK-ORIENTED TRAINING OF LOWER LIMB ON BALANCE AND FUNCTIONAL INDEPENDENCE IN PATIENTS WITH CHRONIC STROKE: A RANDOMIZED CLINICAL TRIAL

Hafsa Zahid — 2024-01-05

Background of the Study: To compare the effects of relaxing music therapy with task-oriented training of lower limbs on the balance and functional status in patients with chronic stroke.

Methodology: This randomized clinical trial was conducted in three outpatient physiotherapy clinics in Lahore, Pakistan. A sample of 76 participants with chronic stroke, aged 40-60 years, and on assistance walking, were recruited through a purposive sampling technique. Individuals who had physical impairments and visual or hearing deficits were not included in the study. Group A received task-oriented training with routine physical therapy while Group B received Music therapy additionally. Three sessions on alternate days per week for eight weeks were given. Balance and functional independence were the outcome variables measured using the Berg Balance Scale and Functional Independence Measure respectively. Mann-Whitney U test and Friedman ANOVA were applied for between-group and within-group differences respectively. P-value was significant at ≤0.05.

Results: The mean age of participants was 54.05 ± 3.64 years, the majority i.e., 55 (72.4%) were male, 46 (60.5%) had ischemic stroke and 53 (69.7%) were presented with left-sided weakness. A statistically significant difference was observed among both groups in balance (p =.000) and functional independence (p=0.000). The within-group difference was also significant for balance (p=0.000) and functional independence (p=0.000).

Conclusion: The integration of relaxing music therapy, task-oriented training, and routine physiotherapy is effective in improving balance and functional independence in chronic stroke patients.

EFFECTS OF KINESIO-TAPING VS DRY NEEDLING IN THE MANAGEMENT OF MECHANICAL LOW BACK PAIN

Adeela Asad — 2024-01-05

Background of the study: Mechanical pain of musculoskeletal origin, known as nonspecific LBP (NSLBP), has symptoms that change depending on the type of physical activity [1]. About 85% of her LBP patients present in primary care settings are NSLBP patients.

Methodology: Randomized control trial (RCT) conducted between between January 2020 and October, 2021, Rawal General and Dental Hospital and Al-Nafees, the hospital in Islamabad. Thirty patients were included in the study. Two participants were discontinued. There were two groups of patients i.e., 15 patients in the KT group and 13 patients in the DN group diagnosed of NSCLBP by orthopedic surgeon and referral to outpatient physiotherapy clinic. The Sample size was calculated using the OpenEpi scale. The Consent form was filled out by the participants before the initiation of the study. Pain Rating Scale, Roland-Morris Disability Index Questionnaire (RMDQ) and Global patient rating scale (PGR) were assessed at baseline, two weeks post-intervention and four weeks post-treatment.

Results: Before treatment, there were no differences between the groups for PNRS, RMDQ and PGR. Both DN and KT produced significant improvements in all baseline measures (PNRS, RMDQ and PGR) after two weeks and four weeks of treatment (p<0.05). Considerable improvements were observed in all variables in both groups after treatment. However, Statistical analysis ANOVA showed no significant differences in almost all measures between groups. (p>0.05).

Conclusion: Kinesio-taping is as effective as DN in managing back pain. When treating back pain, adding DN or KT to your exercise program can make a significant contribution to your treatment.

January to June Content

pjradmin — 2023-01-05

Volume 13, Issue 1

EFFECTS OF PHYSICAL THERAPY-BASED MANAGEMENT APPROACHES FOR TENSION TYPE HEADACHE

Aribah Ahmed — 2024-01-05

Background of the Study: Multiple Physical Therapy approaches have recently been developed and reported in the literature for providing better results in the treatment regimens of tension-type headaches. The advancement in the field of Physical therapy towards the treatment approaches of tension-type headaches has become the driving force for writing this article.

Methodology: Studies comparing the effects of physical therapy management with conventional treatment approaches are included in the meta-analysis. PRISMA guidelines were used for performing the qualitative analysis and assessment of risk of biases.

Results: According to the findings of nine randomized controlled trials, the analysis of the results had revealed that physical therapy intervention demonstrated a significant improvement in reducing headache severity. In a random effect model, the pool effects of physical therapy strategies in terms of Standardized Mean Difference had an impact of 1.41, which according to a Cohen rule of thumb displays a larger effect of physical therapy management in significant decrease in pain intensity among tension-type headache patients

Conclusion: The study has concluded that physical therapy-based management strategies as provided in several RCTs analyzed in this review article revealed a pool effect of moderate size in managing the frequency of pain and a larger effect size in managing pain intensity and duration. Further, it was concluded that tension-type headaches can be effectively managed through physical therapy-based approaches.

EFFICACY OF EXERCISE-BASED TECHNIQUES TO TREAT STRESS URINARY INCONTINENCE IN FEMALES EXCEPT FOR KEGELS TECHNIQUE: A NARRATIVE REVIEW OF THE LATEST EVIDENCE

Sameera Mushtaq — 2023-01-05

Background of the study: Urinary incontinence is a physically challenging and socially incapacitating situation with a loss of self-confidence. This study aims to narrate the latest literature on the efficacy of novel exercise-based techniques to treat stress urinary incontinence except the traditional exercise using Kegel’s method.

Methodology: The electronic searching was done using Google Scholar, Cochrane Library, PubMed, Science Direct, and BMC journals for the latest available at least three articles, including novel exercise regimes to treat stress urinary incontinence. The included techniques are Pilates, Paula Method, and the abdominal Hypopressive exercise technique. All the articles were analyzed, and their results are compiled in tabulated form in this narrative review.

Results: All the approaches like Pilates, Paula, and Hypopressive abdominal exercises are effective for the treatment of stress urinary incontinence. None of the regimes was found to be completely ineffective; however, the range of usefulness may vary.

Conclusion: This study asserts the ideology of inclusion of new therapies into clinical practice keeping in mind their latest literature-based evidence.