The Rehabilitation Journal

EARLY PHYSICAL THERAPY INTERVENTION CAN REDUCE THE CHANCE OF RESPIRATORY COMPLICATIONS IN COVID-19

Syed Alamadar Hussein — 2024-03-03

Since the start of 2020, a COVID-19 emerged as a new strain of Coronavirus. Initially, it affected the population of Wuhan, China and after that it outspread all over the world and was declared as a pandemic by World Health Organization on 30th January, 2020.¹ It has been identified that COVID-19 can cause mild illness including common cold to more severe condition known as acute respiratory distress syndrome (ARDS), if not treated promptly.² While people of all ages are susceptible to COVID-19, those over 60 years of age and with cardiovascular diseases along with diabetes have even more chances of becoming seriously ill Whereas children seem to be less affected.³ Currently there is no pharmacological treatment, still some antiviral drugs have been proven to be helpful along with plasma transfusion in which plasma is extracted from the blood of patient who got recovered from COVID-19 an is transfused into the patient still suffering from the said disease.⁴

Symptoms of respiratory complications due to this disease influence the mind of a Physical Therapist (PT). Though after discussing the maneuvers of respiratory Physical Therapy with fellow professional colleagues as well as clinicians and practically applying it on respective relatives, friends and advice seekers after getting the informed consent from them; those who started to have initial symptoms of COVID-19 before being tested positive and then later got positive. It resulted in great ease for most of them to breathe and did not led to serious respiratory complications that include dyspnea and accumulation of thick and tenacious secretions inside the lungs, which ultimately is a precursor of pneumonia. Following were the PT interventions suggested to the patients showing acute symptoms;

Steam inhalation, breathing exercises and postural drainage positions were inculcated in the treatment plan and guided respectively, steam inhalation therapy is normally advised to be used as primary care in acute respiratory diseases.⁵ It is most commonly used therapy at home and is inexpensive, moreover it promotes self-reliance in the patients; it is used therapeutically by inhaling steam through nose so that it reaches the respiratory system.^6-8 Steam inhalation helps in loosening the mucus, it opens the nasal airway passages decreases mucosal inflammation and heat can prevent replication of viruses.⁹ It helps to relax muscles and relieves coughing by preventing excessive dryness in the mucosal membranes.¹⁰

Moreover, breathing exercises have been reported to have beneficial effects in improving symptoms and optimizing pulmonary function in patients. Breathing programs have been reported to have positive effects in alleviating symptoms and optimizing pulmonary function in patients.¹¹ Breathing exercises aim to improve the individuals breathing pattern and increase in lung expansion, they also enhance the performance of respiratory muscles thus leading towards increase in functional residual capacity, and inspiratory reserve volume.¹² Breathing exercises reduces breathlessness, increase exercise capacity and improve overall well-being of a person ¹³^,14,15,16 The physiological effect of breathing exercises comprises of increase in intra-bronchial pressure thus preventing the collapse of bronchi and leading towards increase in inspiratory and expiratory flow rate.^13,¹⁵ It act by stimulating the autonomic system thereby promoting relaxation and in return improves the physiological parameters.¹⁶

Furthermore, body positioning improves the efficiency and effectiveness of both primary and accessory muscles of breathing leading to ease in dyspnea and reduction in work of breathing.¹⁷ These positions improve the ventilation perfusion ratio and utilize the gravity to remove secretions.¹⁸ Positioning decrease the ventilation demand resulting in longer expiratory time thereby preventing hyperinflation and ultimately resolving dyspnea.¹⁹

As a healthcare professional and specially a Physical Therapist we would like to ask the imminent researchers to fill this gap by conducting different surveys and trials. Through our experience we’ve found that the manoeuvres we applied have been very effective and improved the overall outcome of the patients suffering from COVID -19.

EFFECTIVENESS OF FRAGILITY FRACTURE INTEGRATED REHABILITATION MANAGEMENT FOR IMPROVING ACTIVITY OF DAILY LIVING AND QUALITY OF LIFE IN GERIATRIC POPULATION AFTER HIP FRACTURE

Anam Aftab — 2024-03-03

Objective: The objective of the study was to determine the efficacy of Fragility Integrated Rehabilitation Management (FIRM) on the quality of life and activities of daily living in geriatric population with hip fracture and to reduce the recurrence of hip fracture. Material and Method: A single-group, pretest–posttest design was conducted at Seoul National University for a time period from August 2017 to January 2018 in Bundang Hospital, South Korea. Patients with age of 55 years and above, had diagnosed femoral neck fractures, reduction and internal fixation, intertrochanteric and sub-trochanteric fractures, total hip replacement (THR), bipolar hemi-arthroplasty were included in the study. Quality of life was assessed through the Euro-QOL (EQ-5D) questionnaire, while ADL’s was measured through Modified Barthal Index (MBI). Non-parametric Wilcoxon Sign Rank test was used for pre- post analysis by using SPSS version 21. The level of significance was set at 95% CI (p<0.05). Results: Wilcoxon signed rank test showed a significant improvement in activities of daily living (p<0.05). Furthermore, significant improvement has also been determined in the quality of life (p<0.05), after the 10th Fragility Integrated Rehabilitation Management (FIRM) and 4 Occupational Therapy (OT) sessions. Conclusion: Fragility Integrated Rehabilitation Management showed a significant improvement in the Activities of Daily Living (ADLs) and Quality of Life (QOL).

Keywords: Fragility fracture,geriatric, hip fracture, physical therapy, occupationaltherapy, rehabilitation.

PHYSICAL ACTIVITY AS COPING STRATEGY FOR ACADEMIC STRESS AMONG UNDERGRADUATE FEMALE STUDENT

Hamsa Ashraf — 2024-03-03

Objective: To determine the effectiveness of physical activity as a coping strategy to reduce academic stress among undergraduate female students. Methodology: A Randomized control trail (NCT04221022) was conducted in Bilquis Postgraduate College for Women PAF, Nur Khan Base, Rawalpindi. A total of n=37 undergraduate inactive female (>1-month) students, age between 18-24 years, with moderate level of academic stress measured on academic stress scale were included in the study. While students with diagnosed psychological disorders, systematic diseases were excluded. The participants randomly divided into Light Physical Activity (LPA), Moderate Physical Activity (MPA) and Vigorous Physical activity (VPA) groups. The academic stress scale (ASS) was used to observe level of academic stress among participant at baseline and after six weeks of intervention. Results: The mean age of female study participants was 20.24±1.44 years. Pre-Post analysis showed that all group significantly improve (p<0.001) level of academic stress after 6 week intervention. The academic stress was significantly improved in moderate PA group as compare to vigorous PA (15.17±12.39 Ver. 44.62±36.94, p=0.019). Conclusion: All types of physical activities were effective as a coping strategy for reducing academic stress among female undergraduate students. But moderate level of physical activity like brisk walking was significantly associated with reduction in academic stress as compare to vigorous and light physical activities. Keywords: Cognition, mental health, physical activity, stress.

EFFECTS OF NON MECHANICAL HORSE BACK RIDING ON BALANCE IN SPASTIC CEREBRAL PALSY CHILDREN: A RANDOMIZED CLINICAL TRAIL

Nabeela Kanwal — 2024-03-03

Objective: To compare the effectiveness of non-mechanical horseback riding with conventional Physical therapy on dynamic balance within spastic CP children. Material and Method: A single blinded randomized clinical trial conducted at THQ hospital Gujar Khan Pakistan. The n=30 spastic hemiplegic CP children with Gross Motor Function Classification scale (GMFCS) level-IV, a score of II on Modified Ashworth Scale (MAS) were included through non-probability convenience sampling technique. The participants were randomly allocated into conventional physical therapy (CPT) group and non-mechanical horseback back riding (NMHBR) group through lottery method. The data was collected at baseline and post 06 months through the General demographic questionnaire, MAS, GMFCS and Pediatric Balance Scale (PBS). For between-group comparison independent samples t-test was used while for within-group analysis paired sample t-test was used. Results: The mean age and BMI was 8.36±2.15, 14.5±0.75 respectively. When Comparing both groups, no significant difference was observed in Spasticity (p=0.130) and functional independence (p=0.216). But NMHBR group showed significant improvement in overall pediatric balance score as compare to CPT group (17±10.24 vs. 26.33±1429, p=0.049), after 6 months of intervention. The PBS’s task including standing unsupported (p=0.027), Standing with eyes closed (p=0.039), standing with feet together (p=0.021), Standing with one foot in front (p=0.016), Standing on one foot (p=0.039) and Reaching forward with outstretched arm (p=0.012) significantly improved in NMHBR groups as compare to CPT. Conclusion: It was concluded that conventional physical therapy and non-mechanical horseback riding both can improve spasticity, functional independence and balance of spastic CP children but NMHBR is more effective than CPT. Keywords: balance, hippo-therapy, physical therapy.

LEVEL OF PHYSICAL ACTIVITY AND ITS ASSOCIATION WITH HB LEVEL AMONG DPT STUDENTS

Khadija Shiraz Khan — 2024-03-03

Objective: The objective of this study was to evaluate the level of physical activity and its association with hemoglobin level among undergraduate students. Method and materials: A cross-sectional study was conducted on undergraduate students of Isra Institute Rehabilitation Sciences, Isra University Islamabad. The undergraduate students between 18- 25 years were included in the study. The hemoglobin level was evaluated through the hemoglobin-meter and physical activity through the International Physical Activity Questionnaires IPAQ-SF-7. The Pearson product-moment correlation was used to find association between physical activity and hemoglobin level. Results: The mean age of study participants was 21.10±1.76. Of the 400 participants, 22% participants had low level of physical activity, 46.25% participants had moderate level of physical activity and 31.75% participants had vigorous physical activity. The time spent in vigorous and moderate physical activity was significantly associated with the hemoglobin level (p<0.05) and sitting was negatively correlated with Hb (p<0.05). Conclusion: It was concluded that that levels of physical activity was significantly associated with the hemoglobin level. Keywords: Physical activity, hemoglobin, anemia.

COMPARISON OF VISUAL ACTION THERAPY AND AUDITORY COMPREHENSION THERAPY FOR LANGUAGE FUNCTIONS IN PATIENTS WITH WERNECK’S APHASIA

Zainab Ijaaz — 2024-03-03

Objective: to compare the effectiveness of visual action therapy (VAT) and auditory compression training (ACT) for language functions in patients with Wernicke Aphasia. Methodology: A Pilot Randomized Clinical trial was conducted. Patients with age range of 30- 60 years with neurological impairments and aphasia were included in the study. The participants n=12 were recruited through purposive sampling technique and randomly divided in to two groups through lottery method. One group received visual action therapy while other group received auditory comprehensive training. Each participant in both groups received three sessions per week in their homes for a time period of 10 weeks. The data were collected through Western Aphasic Battery (WAB). Results: The Mean of age of study participant in VAT and ACT as 51.83±7.83 and 60.3±2.05 respectively. In this study significant improvement has been observed after 10 weeks of intervention in visual action therapy group (p<0.05). Conclusion: It is concluded from the results that VAT significantly improved the western aphasic battery scoring and comprehension skills in patient with Wernicke’s aphasia. Key words: Auditory comprehension therapy, visual action therapy, Wernicke aphasia