Physiotherapy and Occupational Therapy Journal

 Introduction: Stork is a global epidemic and an important cause of morbidity and mortality. As defined by WHO stroke is “rapidly developing clinical sings of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, no apparent cause other that of vascular origin” [1]. Mirror therapy is a relatively new therapeutic intervention which is simple, inexpensive and most importantly patient directed treatment that focuses on moving the unimpaired limb. It was first introduced by Ramachandran and Roger Ramachandran to treat phantom limb pain after amputation [2]. In stroke patients, this technique involves performing of unimpaired limb while watching its mirror reflection superimposed over the (unseen) impaired limb, thus creating a visual illusion of enhanced movement capability of the impaired limb [2]. Aim of the Study: To analyze the effectiveness of combine motor rehabilitation protocol to improve upper extremity motor recovery in post stroke subjects. Methods: A total of forty subjects were selected based upon the inclusion and exclusion criteria. The 20 out of the 40 subjects were asked to maintain static joint posture for the neck. The postures included were flexion, extension, right and left side flexion and right and left rotation. The subjects were asked to maintain this posture in the sitting position. The remaining 20 subjects were asked to maintain the same static joint posture in sitting position for the neck but in reverse order. The first 20 subjects were then asked to maintain static joint posture for the low back in sitting position. The postures included were flexion, right and left side flexion and right and left rotation. The remaining 20 subjects were then asked to maintain the same static joint posture for the low back in sitting position but in the reverse order. Discussion: Mirror therapy and RFE relatively a new treatment techniques developed to promote upper extremity recovery in stroke patients. Previous studies in stroke suggested that MT and RFE may be beneficial for motor function and is a simple, inexpensive and most importantly patient directed treatment that improve upper extremity function. Hun-Chiaet 2010 and Gunes Yavuzer in 2008, supported that UEFI is a preferred upper limb regional tool due to its superior and comparable psychometric properties. The result of the study confirm that the MT and RFE has improved upper limb function as demonstrated with UEFI. Clinically this study demonstrated that by using MT and RFE as a treatment tool, the improvement was seen in upper extremity functional activity of post stroke hemiparetic subjects. Conclusion: Mirror therapy and repetitive facilitation was found to be effective in improving functional independence in upper limb post sub –acute stroke. When mirror therapy and repetitive is administe 3rd to patient suffering from sub-acute stroke over a period of 4 weeks, it results in an improvement in reaching forwards, grasping, manipulating objects and also improves others fine motor functions of the hand. Limitations of the Study: The duration of study was only 4 weeks, Home exercise were not prescribed to the subjects and Training depending on functional level of patients.

Keywords: Mirror box; Table; Chair; Ball; Jar; Bag; Comb; Suitcase; Treatment couch; Shirt with buttons and Shoes with laces.

 Introduction: Chronic bronchitis (CB) is a common but variable phenomenon in chronic obstructive pulmonary disease (COPD). It has numerous clinical consequences, including an accelerated decline in lung function, greater risk of the development of airflow obstruction in smokers, a predisposition to lower respiratory tract infection, higher exacerbation frequency, and worse overall mortality [1]. Need of the Study: There are many research done on breathing exercises & bronchial hygiene techniques for chronic bronchitis but n comparison between active cycle of breathing technique along with postural drainage over autogenic drainage. This study is focused to find out the effects of active cycle of breathing technique along with postural drainage over autogenic drainage. Hypothesis: Experimental Hypothesis There is significant difference between the effect of Active cycle of breathing technique along with postural drainage over autogenic drainage in chronic bronchitis patients. Null Hypothesis: There is no significant difference between the effect of Active cycle of breathing technique along with postural drainage over autogenic drainage in chronic bronchitis patients. Review of Literature: Ada Clarice Gastaldi, PhD, (2015) This study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD). 15 COPD outpatients with thirty minutes of flutter exercises: a “flutter-sham” procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed. The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions [22]. 2. EleonoraVolpato, Paolo Banfi, (2015) This meta-analysis aimed to assess evidence from the scientific literature on the effects of relaxation techniques, investigated 9 databases to select 25 RCTs. Although higher quality research is required, our results sustain the importance of relaxation techniques as a tool to manage COPD [23]. 3. Susan D Hanekom, Dina Brooks, 2012) Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in preoperative care. An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated [24]. Methodology: 30 Subjects divided randomly into two groups; namely experimental group A and control group B, consisting of 15 subjects each. Both the groups were assessed before the training session to exclude any pre-existing pulmonary and cardiac conditions. Group A was treated with Active cycle of breathing technique with postural drainage and Group B received autogenic drainage. Discussion: This study was design to compare effectiveness of two airway clearance techniques. It was a comparative study, 30 patients with chronic bronchitis are taken subjects divides into Group A and Group B. 30 patients of chronic bronchitis of each group are distributed by convenient sampling. Group A was performed with active cycle of breathing technique along with postural drainage; Group B was performed with autogenic drainage only, duration for 4 weeks. Statistical ‘t’ test for analyzing pre and post result. In this study Conclusion. This study, concluded active cycle of breathing technique with postural drainage and autogenic drainage are effective individualy but comparatively there is no significant difference between two groups. Limitations of Study: 1. The sample size in this study was small, larger sample was not taken. 2. As the study was done on chronic bronchitis patients, it can be done on other COPD patients. 3. Sometimes the patients are uncooperative, unconcious and no longer stayed. Suggestions for Further Studies: 1. This study used only four tools in detecting the improvement in chronic bronchitis patients, studies can be done with other parameters like pulmonary function testing and arterial blood gas analysis. 2. As this study was done only with smokers, further studies could be done with other types of patients. 3. The comparison between active cycle of breathing technique and other training modes like percussion, vibrations, incentive spirometery can be studied, as the later is also concerned with the better outcome in recent studies.

Keywords: Couch, Peak flow meter; Pulse oxymeter; Timer; Stethoscope; Pillows; Borg’s scale; Oxygen saturation level (SaO2); Peak expiratory flow rate (PEFR); Rate pressure product (RPP) and Borg scale (rate of perceived exertion).

 Introduction: Traumatic Brain Injury is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force [1]. Traumatic Brain injury is also associated with neurological or neuro psychological abnormalities, skull fracture, intracranial lesions. In India and other developing countries traumatic brain injuries are a leading cause of morbidity, mortality, disability and socioeconomic losses. In India nearly 1.5 to 2 millions are injured and 1 million deaths are occurring [2,3]. Ganesan et al. reported statistical significant improvement in level of consciousness between the groups (p<0.05) and there was no significant improvement in the neurobehavioral function between the groups after right median nerve stimulation of traumatic brain injury. There may be relationship between superior levator palpebrae muscle, right median nerve and ascending reticular formulation in improving consciousness of traumatic brain injury subjects. None of the studies documented the relationship between them [22]. Aim of The Study: To analyze the effectiveness of sensory stimulation program with median nerve stimulation in post head injury subjects with decreased level of consciousness. Methods: The basis of inclusion and exclusion criteria 30 subjects were randomly divided into two groups. 15 subjects in experimental group (Group A) and 15 subjects in controlled group (Group B). A pretreatment scoring was done via Glasgow coma scale (GCS) and coma recovery scale (CRS). Group A is experimental group and received Sensory stimulation program with right median nerve stimulation (SSP) and Group B is controlled group & this group received conventional therapy as chest PT, Passive Movement, PNF and positioning of the patient. Discussion: Severe brain injury is a cause of for high morbidity and mortality rates. Individuals who sustained severe acquired brain injury, experience prolonged disorders of consciousness. The current study was conducted to compare the effectiveness of multisensory stimulation program with median nerve stimulation in post head injury subjects with decreased level of consciousness. The present study suggested that the sensory stimulation programme along with median nerve stimulation is associated with higher level of consciousness determined by the GCS when compared to the other group in comatose TBI patients. There is a gradual increase in the level of consciousness in the experimental group during 4 weeks of intervention. These findings demonstrated that the significant changes in the GCS, CRS scores are not representative of single day intervention but are rather related to the effect of collective intervention over the course of 4 weeks. Kater, mitchell et al. The result of this study suggested that implementation of sensory stimulation long with median nerve stimulation can enhance consciousness recovery in comatose traumatic brain injury patients. Samond et al. The changes in the ANS while regaining consciousness could be due to the recovery of higher cortical structures controlling the ANS and nuclei releasing the neuro transmitters involved in the ANS. Johnsons et al. considered other indices such as catecholamine, serotonin, acetylcholine esterase 3-methoxy 4-hydoxyphenylgycol skin conductance and heart rate as evidence of the effects of sensory stimulation. The control group (Group B) showed non- significant result of p>0.05. In this group conventional physiotherapy with passive exercise and shows non- significant results after 4 weeks when compared to pre- intervention scores. This states that conventional physiotherapy with passive exercise and chest physiotherapy are not sufficient for speedy and significant outcomes. Clinically, this study demonstrates that sensory stimulation programme along with median nerve stimulation as a treatment tool, improve the level of consciousness post treatment brain injury subjects. Future Research: Further studies are recommended to minimize these limitations in such a way that larger sample sizes of both the sexes, the duration of the study can be increased, Sensory stimulation should be applied for more than 4 weeks, sensory stimulation could focus on performing long term follow up to compare cognitive and functional activities outcomes in unconscious patients with traumatic brain injury. Limitation of the Study: Duration of the study was short. There was no follow up. Half of the patients were surgically operated on for brain injury and these patients were not uniformly distributed across the sample. It was not ascertained whether the improvement were maintained for a longer period or not due to lack of follow up in the study. Conclusion: Sensory stimulation programme with median nerve stimulation was found to be effective in improving levels of consciousness in subjects with traumatic brain injury. When sensory stimulation programme with median nerve stimulation is administered to the patients suffering from traumatic brain injury over a periods of 4 weeks results in improving the levels of consciousness and there by promotes faster recovery due to significant effects on GCS and CRS when compare to patients who did not receive sensory stimulation programme with median nerve stimulation.

Keywords: Head injury; Sensory Stimulation Programme; Glasgow coma scale; Coma Recovery Scale; Median nerve stimulation.

 Background: Now these employees, so called patients came to Occupational Therapist for treatment. Then Occupational Therapists first do treatment of pains by using some physical Modalities as well as an Activity program. So it is very necessary for Industrial area that they should have a standard Occupational Therapy Protocol for avoiding spinal problems. So the persons who are working in industrial set-up will have a fruitful life and pain free working environment. Need of the Study: Presently in industrial set up, 90% (ninety percent) of persons are suffering from different problems. Among them approximately more than 60% (sixty percent) persons are having low backache, neck pain. Hence, it was decided to conduct this study as there is very little research work on this industrial population. A standard protocol of Occupational Therapy would be developed for the subjects with Low back pain. Materials and Methods Research Design Post Test Comparison 1. Independent VariablesInterventions- a. Activities and Exercises b. Do’s and Don’t’s for selected Subjects 2. Dependent Variablesa. Pain b. Unable to perform an activity related back pain 3. Subjects-50 subjects are randomly selected from particular age group Results: Clinical Analysis clearly shows excellent improvement in persons working in industrial set up after successful intervention of Standard Occupational Therapy Protocol, which includes Occupational Therapy activities and exercised, Occupational therapy Do’s and Don’t’s and Ergonomic advice. Conclusion: Result of this research is accepted hypothesis that use of Standard Occupational Therapy protocol which includes Occupational Therapy treatment, Do’s and don’ts and Ergonomic advice tremendously reduced symptoms of low backache in persons working with Industrial set up. These persons are more happily doing their work and also with pleasure. Among four questionnaire, for 4 questions means for Four types of complaints, persons (subjects) got relief.

Keywords: Pain; Low back pain.

 Objectives: To compare the clinical effects of lateral wedge foot orthosis with conventional physiotherapy treatment and only conventional physiotherapy treatment in patient with medial compartmental osteoarthritis knee. Group I conventional group, Group II experimental group. Subjects: Thirty (N=30) subjects, age 50-70 years were randomly divide into two groups, Group I conventional group (15 patient) and Group II experimental group (15 patient), who meet the inclusion and exclusion criteria were recruited in the study. Design: An experimental design study. All tests of all subjects were conducted in the physiotherapy O.P.D. of Vidya Institute of Creative Teaching, Meerut, at Jai Physiotherapy and Dental Clinic, SF-06, Ansal Galleria, Ansal Town, Meerut and in the Physiotherapy OPD of Trident College of Education, Meerut. Patient who recruited in the study were assessed on day 1. Then patient were divided randomly into two groups. Group I conventional group (15 patient), Group II experimental group (15 patient). Group I was treated with SWD, US and Exercise. Group II was treated with same as group I and lateral wedge foot orthosis (Height 6.35 mm/ 10 degree, material rubber). Patients were reassessed again at the end of fourth week. Instruction were given to the patient regarding activities which they should not perform like squatting; cross sitting, prolonged standing etc. treatment was for six days a week for four weeks. Data Analysis: All analysis were obtained using SPSS windows. Demographic data of subjects including age was descriptively summarized. The dependent variables for statistical analysis were step length, stride length, base of support, cadence and pain while the independent Variable were Conventional Physiotherapy Treatment and Wedge foot orthosis with lateral raise. One way Multivariate analysis of Variance with repeated measures was performed, to analyze the differences in the gait performances among both the groups. The independent t-tests were performed using the difference scores of variables i.e. pre & post intervention. Significance level of 0.05 was used to determine statistical significance. Results: The results of my study showed that there is definitely some advantage of using a lateral wedge foot orthosis in addition to conventional mode of treatment in osteoarthritis of knee. Statistically the results are not significantly strong for all parameters i.e. step length, stride length, base of support, cadence and pain, but all measures hint towards a better recovery in the performance of the experimental group (Group II) subjects. Conclusion: The results of the study show that biomechanical correction by the use of lateral wedge foot orthosis has an immediate effect which is evident in some of the gait parameters. The changes would be more appreciable if observed for a longer time. The difference in both groups definitely hints towards a better recovery in patients with medial compartmental osteoarthritis of knee when a lateral wedge is used in addition to the conventional physiotherapy treatment. The results of my study supports the hypothesis, within the limitation of this study. The result of this study provides a base for further research as they presents valuable outcomes for practitioners treating the patients with medial compartmental osteoarthritis of knee.

Keywords: CAD (Cadence); BOS (Base of Support); ST (Stride Length); ST (Step Length); GRF (Ground Reaction Force) and VAS (Visual Analogue Scale).

 Background: The effectiveness of standing frame has been investigated in cerebral palsy patients. The present study examine that stading frame was effective or not on constipation in cerebral palsy patient. The study is randomized controlled trial (RCT), enrolled 30 patients with cerebral palsy. All pateints received a standing frame programme, for 8 weeks 5 days a week. Main measures: Bristol stool chart and questionnaire on burden of care. Result: the result calculated individually by the scales. For Bristol stool chart 43.3% of the stool evacuated falls into type 2 in week 1 and 46.7% of stool evacuated in type 3 (p = 0.000) there was a significant difference. Regarding the questionnaire on burden of care table for que. 1 (p = 0.001), Que. 2.1 (p = 0.002), que 2.2 (p = 0.000), que 2.3 (p = 0.002), que 3 (p = 0.001) there shows significant difference and for que 4 ( p = 0.317) were there is no significant difference finding. Conclusion: this study found the benefical effects of standing frame for the management of constipation in cerebral palsy patient.

Keywords: cerebral palsy; constipation; standing frame.

 Aim: The aim of the study was to find out the effectiveness of Occupational Therapy Program for patients with depression. Objectives: To find out the level of Depression for patients with depressive episode. To reduce the level of the Depression. To educate and train the ADL skills (Activities of Daily Living) for patients with Depressive episode. Methods: Ten patients with depressive episode for both male and female patients were selected for this study. All patients were screened by Beck Depression Inventory (BDI), was used for the objective measurement of patient’s Depression level. The pre and post therapy values were statistically analyzed on the effect of Occupational Therapy intervention for patients with depression. Result: The statistical analysis of Beck Depression Inventory (BDI) pre-treatment Mean value is 33.9 SD 1.3203 and post-treatment Mean value is 17.6, S.D 0.52068, t-test value of BDIs is 11.48444 and p value is < .00001. This statistical analysis shows that, there is significant difference between pre and post-therapy values of Beck Depression Scale score. Hence, it is suggested that, the level of Depression were reduced and the ADL skills were trained for patients with depression. Conclusion: Occupational Therapy can be used effectively as one of the most important; interventions to reduce the level of depression and to train as well make them independent in their activities of daily living. Hence, it is recommended that, the Occupational Therapist plays pivotal role in treating patients with depression. Psychiatrist, clinical psychologist and other health care professional may consider these interventions when dealing patients with depression.

Keywords: Depression; Occupational Therapy; Beck Depression Inventory (BDI); Activities of Daily Living; World Health Organization (WHO); National Institute of Mental Health (NIMH); Centers for Disease Control and Prevention (CDC).

 A total of 22 subjects were selected from various cerebral palsy rehabilitation center of Dehradun and met the inclusion criteria were included in the co-relation study. An informed consent of subjects was taken from 22 subjects. Parent had been informed about the purpose and procedure of study and informed consent was obtained. All subjects were evaluated for spasticity, balance and gross motor activity. The data was analyzed finally to find the correlation between spasticity and balance and also between spasticity and gross motor function. The results shows that mean spasticity of knee flexor of both the lower limbs relates fairly with pediatric balance scale (r=-0.433) whereas mean spasticity of plantar flexor shows good negative relationship with pediatric balance scale (r=-0.616) which means that planter flexor spasticity affects balance more than knee flexor spasticity. In our study result showed moderate correlation between average MAS score of both limb and GMFM score. Thus our results suggest that spasticity limit functional performance in a biomechanically predictable fashion in children with cerebral palsy.

Keywords: Spasticity; Gross motor function; Pediatric balance scale.