The Physiotherapy Management of Postoperative Mid-shaft Clavicular Fracture With Brachial Plexus Injury: A Case Report.

Traumatic brachial plexus injury (BPI) is a debilitating condition predominantly affecting young males, often resulting from traction or direct injuries. Due to the complicated neuronal network, the damage is often classified as preganglionic or postganglionic injuries. It includes upper-limb mobility impairments as well as reduced muscular strength and sensitivity. We discuss a case of a 30-year-old female who suffered a displaced mid-shaft clavicular fracture and BPI after a road traffic collision. The patient experienced significant pain, restricted movement, and sensory and motor loss in her left arm. Imaging studies revealed additional complications, including epidural collection and pseudomeningoceles. She underwent open reduction and internal fixation of the clavicle, followed by a structured rehabilitation program focusing on pain management, muscle re-education, and functional recovery. This case highlights the complexity of managing clavicular fractures with concurrent BPI, requiring a multidisciplinary approach involving imaging, surgical intervention, and comprehensive physiotherapy for optimal recovery and functional restoration. Rehabilitation strategies were employed to address the diverse symptoms, including multi-sensory strategies, sensory re-education, graded motor imagery rehabilitation, and gradual restoration of upper extremity (UE) range, strength, and endurance and to develop neuromuscular control. Effective management of clavicular fractures with BPI requires early diagnosis, surgical intervention, and structured rehabilitation to improve functional outcomes and quality of life.

A Review on Osteopathic Manipulation in Patients With Headache.

Headaches are a common neurological disorder, significantly impacting patients' quality of life. Traditional treatments include pharmacological and nonpharmacological approaches. Osteopathic manipulative treatment (OMT) is a holistic, hands-on technique used by osteopathic physicians to alleviate pain and improve function by addressing musculoskeletal dysfunctions. This review aims to evaluate the effectiveness of osteopathic manipulation in managing headaches, focusing on the different types of headaches, the specific techniques used, and the overall outcomes reported in clinical studies. A comprehensive literature search was conducted across multiple databases, including PubMed, Google Scholar, and MEDLINE, to identify relevant studies published in the past two decades. Inclusion criteria were studies involving adult patients diagnosed with headaches and treated with OMT. Both randomized controlled trials (RCTs) and observational studies were included. The review identified 15 studies meeting the inclusion criteria. Evidence suggests that OMT can be beneficial in reducing the frequency, intensity, and duration of headaches, particularly tension-type headaches (TTHs) and migraines. Techniques such as myofascial release, cranial osteopathy, and muscle energy techniques were commonly employed. Many studies reported significant improvements in patients' quality of life and functional status post-treatment. However, the heterogeneity in study designs, sample sizes, and outcome measures warrants cautious interpretation of the results. Osteopathic manipulation shows promise as a complementary approach for managing headaches, with positive effects on pain relief and functional improvement. Further large-scale, high-quality RCTs are needed to confirm these findings and to establish standardized treatment protocols. Integrating OMT into multidisciplinary headache management strategies could potentially enhance patient outcomes and reduce reliance on pharmacological interventions.

Comprehensive Physiotherapy Rehabilitation in a Patient With Cerebellar Ataxia and Dysphagia: A Case Report Investigating Symptomatology, Management, and Outcomes.

A cerebellar infarct occurs when blood flow to the cerebellum, located in the posterior cranial fossa, is disrupted. This diminished blood supply leads to decreased oxygen delivery, resulting in motor and balance control impairments. One prevalent sign of neurodegenerative diseases is dysphagia, which is typically linked to a higher death rate. No systematic and uniform assessment of dysphagia is used in the clinical care environment of individuals with ataxia. Its effect on the quality of life associated with health in patients is little understood. Therefore, this case report works to address dysphagia in cerebellar ataxia. This case report examines the physiotherapy management of a 41-year-old male who had cerebellar ataxia secondary to an infarct in the bilateral cerebellar hemisphere and vermis. The rehabilitation period lasted for six weeks. On examination, the patient had difficulty swallowing and showed symptoms of cerebellar dysfunctions, such as nystagmus, dyssynergia, dysmetria, and dysdiadochokinesia. Neuro-physiotherapy interventions, like conventional physiotherapy, trunk, and pelvis proprioceptive neuromuscular facilitation (PNF), Kinesio taping for dysphagia, interventions to treat gait, balance training interventions, and Frenkel's exercises were commenced. The outcome measures were evaluated using standardized outcome measures like the Swallowing Quality of Life Scale (SWAL-QOL), Severity of Ataxia Scale (SARA), Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), Barthel Index, and World Health Organization Quality of Life (WHO-QOL). We conclude that a properly structured physiotherapy program subsequently improved the symptoms of patients. Furthermore, it enhanced functional independence, which subsequently improved the patient's quality of life.

The Effect of Physical Rehabilitation on Oro-Motor Stimulation, Manual Airway Clearance, Positioning, and Tactile Stimulation (PROMPT) on Neonates With Respiratory Distress Syndrome.

Neonatal respiratory distress syndrome (NRDS) is a significant cause of morbidity and mortality in preterm infants due to insufficient surfactant production in the lungs. This case report explores the effect of physical rehabilitation on oro-motor stimulation, manual airway clearance, positioning, and tactile stimulation (PROMPT) approach on a preterm neonate with NRDS. The report details the pre-natal, natal, and post-natal history of the patient, including maternal health, pregnancy complications, delivery specifics, initial clinical presentation, and subsequent management. Standard treatments such as exogenous surfactant administration and respiratory support were complemented with PROMPT techniques. The outcomes demonstrate the potential benefits of incorporating physical rehabilitation in the management of NRDS, highlighting improvements in respiratory function and overall clinical stability. This case underscores the importance of multidisciplinary approaches in enhancing the care and prognosis of neonates with NRDS.

Effect of Paediatric Rehabilitation in Infantile Systemic Hyalinosis: A Case Report.

Infantile systemic hyalinosis (ISH) is a very rare autosomal recessive disorder, which is characterized by a systemic build-up of hyaline material that causes extensive tissue destruction and functional impairment. The signs of this debilitating illness, which can involve organs, skin anomalies, and joint contractures, frequently appear in infancy. The paucity of available research on ISH emphasizes the need for all-encompassing management approaches to address the wide range of symptoms and enhance the overall quality of life for impacted babies. The interdisciplinary approach to ISH highlights the need for physiotherapy as a crucial element, with an emphasis on addressing the motor and developmental problems linked to the illness. Improving mobility and functional independence in newborns with ISH is facilitated by therapeutic exercises designed specifically for their needs. Here, we present a case of a six-month-old male child who visited a tertiary care center with complaints of minimal movements of all four limbs since birth with the inability to hold the neck. On examination, it was found that there were low-set ears with popular rashes and contractures over distal joints. Electromyography (EMG) and nerve conduction velocity (NCV) were done, which had abnormal findings suggestive of myopathy. On skin biopsy, it was confirmed that the child was suffering from ISH. Thus, the patient was referred to a physiotherapist. After six weeks of physiotherapy sessions, it was found that early and consistent physiotherapy interventions have been linked to a decrease in joint stiffness-related pain and discomfort, improving the affected infants' general comfort. Furthermore, physiotherapy interventions have a crucial role in supporting adaptive methods to get around physical restrictions, making it easier for infants with ISH to reach developmental milestones that could otherwise be difficult. Although there is little research on the effects of physical therapy on infants with ISH, new data indicate that a proactive, tailored physical therapy program can greatly enhance the functional ability of impacted children, improve their overall quality of life, and avert further problems. It is crucial to incorporate physiotherapy into the comprehensive care of infants diagnosed with ISH. This highlights the significance of timely diagnosis, interdisciplinary cooperation, and continuous research aimed at improving and optimizing physiotherapeutic therapies for this uncommon and crippling genetic illness.

Integrating Physiotherapy in Neuroleptic Malignant Syndrome Management: A Case Report.

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal condition characterized by hyperthermia, autonomic dysregulation, altered mental status, and muscular rigidity. It typically results from the blockade of dopamine receptors by antipsychotic medications. We present the case of a 70-year-old female who developed NMS after non-compliant use of clozapine. She presented with symptoms including irrelevant talk, breathlessness, and generalized muscle weakness. On examination, she was drowsy with a Glasgow Coma Scale score of 11, tachycardia, tachypnea, and hypertonicity in all limbs. Diagnostic evaluations revealed increased urea and creatinine levels, raised creatine phosphokinase, and metabolic acidosis, which are consistent with NMS. Medical management included the discontinuation of clozapine and the initiation of bromocriptine. The report emphasizes how important physical therapy is to the NMS recovery process. The goals of physical therapy were to improve functional mobility, lessen muscle rigidity, and avoid problems from extended immobility. Kinesthetic stimulation, active cycle breathing methods, soft rocking motions, neural warmth, weight-bearing exercises, and mobility training were all incorporated into the protocol. Significant progress was observed in the patient's degree of consciousness, movement, and oxygen reliance over a two-week period. With the patient eventually managing room air without additional oxygen, the Glasgow Coma Scale score improved, and the ICU Mobility Scale score increased from 1 to 5. This instance emphasizes the need for prompt diagnosis and all-encompassing NMS care, with physiotherapy playing a critical role. Physiotherapy can significantly enhance overall healing, improve respiratory function, and facilitate neuromuscular re-education through tailored therapies. The results indicate that physiotherapy has to be regarded as a crucial component of the multidisciplinary strategy for managing NMS, with the goal of enhancing patient outcomes and quality of life. More studies are required to optimize physiotherapy interventions for NMS patients.

Effect of Pediatric Rehabilitation on Children With Attention Deficit Hyperactivity Disorder (ADHD): A Case Report.

This case study examines a three-year-old male child with attention deficit hyperactivity disorder (ADHD) who exhibits fine motor impairments, language and speech delays, and delayed social milestones. The therapeutic intervention included a comprehensive program involving parent education, parental behavioral therapy, sensory integration therapy, treadmill walking, music therapy, and the Picture Exchange Communication System (PECS). The results showed significant improvements in the child's functional independence, behavioral management, and communication abilities, highlighting the efficacy of the multifaceted physiotherapy approach.

Effects of Closed Kinetic Chain Exercises in Chemotherapy-Induced Peripheral Neuropathy: A Case Report.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction to many first- and second-line chemotherapy medications that can be debilitating, severe, and often dose-limiting. Treatment options for CIPN are limited. We report a case of a 52-year-old female patient with Stage II ovarian cancer who was hospitalised in the chemotherapy ward for a second round of chemotherapy. We describe the effectiveness of closed kinetic chain (CKC) exercises for the management of CIPN symptoms. The patient was advised to take neurophysiotherapy. The patient complained of pain, tingling in both feet, weakness in the lower limbs, and trouble keeping her balance while walking. Thus, three days after the start of the chemotherapy drugs, physical therapy rehabilitation was started. The patient stated total pain reduction and a noticeable improvement in tingling and numbness in both lower extremities following four weeks of physical therapy. Even though CIPN usually disappears gradually over time, it can persist for an extended period. It seems doubtful that this was a spontaneous resolve, given the regularity of her symptoms before starting physiotherapy sessions and their quick recovery with treatment. Further investigation is required to comprehend the role that physiotherapy and non-pharmacologic interventions play in ameliorating CIPN symptoms and to ascertain if improvements in CIPN symptoms are associated with an increase in blood flow directly or indirectly.

Improving Healing: The Putative Effects of Low-Level Laser Therapy for Ulcer in Parkinson's Disease.

The progressive nature of Parkinson's disease and its associated motor and non-motor symptoms can lead to various complications when patients experience immobilization, exacerbating existing motor impairments and potentially giving rise to secondary health issues. The variability, progression, and management of tremors in PD can be challenging. Due to low bone mass density, patients with Parkinson's disease are susceptible to vitamin D deficiency. The lack of movement can worsen muscle rigidity and stiffness, leading to contractures and a decreased range of motion in joints. Additionally, immobility may contribute to cardiovascular deconditioning, orthostatic hypotension, and an increased risk of pressure ulcers due to prolonged pressure on specific areas of the body. In this case report, we hereby report a case of Parkinson's disease further complicated by sinus discharge from the ulcer. This case report describes the putative effects of low-level laser therapy on discharging sinus from the wound secondary to a diabetic ulcer in idiopathic Parkinson's disease. Achieving an ideal level of functional independence and preventing problems associated with extended immobility are essential goals of structured physical therapy postoperative care. This may assist the patient in returning to their pre-injury position more quickly. Our patient underwent several interventions for wound healing, including proprioception training, tremor management, improving dynamic trunk balance, and pain control measures. Clinical outcome measures like the Barthel Index, lower extremity functional scale, and Visual-Analog Scale were used to assess the progress of the patient. Managing these interconnected conditions requires a multi-disciplinary approach.

Effect of Osteopathic Manipulation in an Autism Spectrum Child With Speech Impairment and Attention Deficit: A Case Report.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in communication, social interaction, and repetitive behaviors. Children with ASD often experience comorbidities such as speech impairment and attention deficit, which can significantly impact their quality of life and ability to engage in daily activities. This case report aims to investigate the potential benefits of osteopathic manipulation in addressing speech impairment and attention deficit in a child diagnosed with ASD. A four-year-old male child diagnosed with ASD, presenting with speech impairment and attention deficit, received a series of osteopathic manipulation sessions over a period of 12 weeks. The treatment protocol was tailored to address musculoskeletal dysfunctions, cranial restrictions, somatic dysfunctions, and digestive system dysfunctions identified through osteopathic assessment. Following the osteopathic manipulation sessions, improvements were observed in the child's speech fluency and attention span. The child demonstrated increased engagement in communication activities and showed enhanced focus during therapy sessions. Additionally, improvements were noted in the child's overall behavior and social interaction skills. This case report suggests that osteopathic manipulation may be a beneficial adjunctive therapy for children with ASD experiencing speech impairment and attention deficit. Further research with larger sample sizes and controlled study designs is warranted to validate these findings and elucidate the mechanisms underlying the observed improvements. Osteopathic manipulation holds promise as a non-invasive, holistic approach to addressing various aspects of ASD, contributing to the multidisciplinary management of this complex condition.

Impact of Spencer Technique on Pain, Range of Motion, and Functional Disability in Patients With Frozen Shoulder: A Pilot Study.

Background and objective The shoulder is the most flexible ball- and socket-type joint in the human body. The pathological condition that can commonly affect this joint is the frozen shoulder. This condition is marked by pain and stiffness in the area surrounding the shoulder complex. This leads to difficulty in doing the daily activities of living. Exercise and physical therapy are mostly recommended to decrease pain and improve and maintain the range of motion (ROM). Mainly traditional techniques such as Mulligans, Maitland, and Kaltenborn are used, along with electrotherapy and exercises, for the treatment of this condition. The effect of the Spencer technique is seen in baseball players' shoulder function. Thus, the purpose of this study is to determine how the Spencer approach affects patients with frozen shoulders in terms of pain, ROM, and functional impairment. Methodology This study included 20 patients aged between 40 and 60 years with stage 2 and 3 diagnosed frozen shoulder. This is a single-group pilot study that received the Spencer technique along with a moist heat pack and Codman's exercises on the affected shoulder for three weeks. Outcome measures used for assessment before and after treatment were the visual analog scale (VAS), shoulder ROM, and shoulder pain and disability index (SPADI). After the second, third, and sixth months, a follow-up was conducted. Two patients were lost to follow-up; consequently, statistical analysis was performed on the data from 18 patients. Results The current study's results suggested that there was an improvement in the mean values of VAS, ROM, and SPADI at post-three weeks, and a sustained effect was observed at the second, third, and sixth months. A statistically significant difference (P < 0.05) was found. Conclusions The study's conclusions demonstrated improved pain, ROM, and SPADI scores post-intervention. Treatment effects persisted, as seen by follow-up at the two, three, and six-month marks. As a result, the Spencer technique utilized in this pilot study on frozen shoulder patients proved effective. Also, the outcome effects were sustained, which suggests its utility in frozen shoulder rehabilitation.

Promoting Survival and Primitive Reflexes to Prevent Brain Imbalance in Premature Infants: A Scoping Review of New Insights by Physiotherapists on Developmental Disorders.

Survival reflexes, originating from the brainstem, are involuntary motor responses that are present at birth and facilitate the survival of the neonate. The age of the baby is critical enough to give information about the maturation of these reflexes. In the case of preterm babies, the delayed maturity of these reflexes may pose a threat to the life of the newborn. One can perceive what the baby can feel, taste, smell, see, and hear through reflex maturation. The objective was to identify and understand the role of survival reflexes and primitive reflexes and their importance in premature children. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, The Cochrane Library, Scopus, and Web of Science were the electronic databases used from January 2017 until November 2022. We included the original articles, reviews, and randomized clinical trials that focused on the importance of survival reflexes. Later on, all the articles were systematically arranged as per the information they provided, and 101 titles were selected, of which 32 met the inclusion criteria. Various articles were written regarding the present literature about primitive reflexes, but none promoted them in the neonatal intensive care unit (NICU). This review is regarding the use of survival reflexes to improve the outcomes of neonates, specifically in the NICU. Simple interactions with the environment are made possible by primitive reflexes, which also serve as the foundation for early movement. This review presents a better understanding of the maturation of survival reflexes and primitive reflexes and provides further insight into how a physiotherapist can concentrate on the early identification and development of these reflexes to prevent further complications. Assessing the primitive reflex in the NICU will help in the early identification of developmental delay and further help us predict reflex maturation. Promoting them will provide positive outcomes in terms of neonatal development. A physiotherapist can play a vital role starting from the NICU to get the baby into an environment similar to the mother's womb and therapy to get the early maturation of the reflex.

A Pragmatic Neuro-Rehabilitation Approach for Basilar Invagination: A Case Report.

Basilar invagination is a rare pathology of the occipital bone, along with prolapsing of the vertebral column. It is a narrowing in the opening of the foramen magnum of the odontoid process. It is a well-known cause of pain and tingling in the upper limbs. However, only a few afflictions requiring physiotherapy rehabilitation in basilar invaginations have been reported. Thus, this study was carried out to investigate a case of basilar invagination. A 51-year-old female visited the neuro-outpatient department. The chief complaints of the patient were restricted overhead activities, restricted neck and shoulder movements, upper limb weakness, and tingling of bilateral upper limbs for the past two months. Clinical examination revealed pain thresholds for the neck and shoulder at nine by ten on activity and five by ten on rest. Manual muscle testing revealed a significant reduction in the strength of muscles around the neck and shoulder at three by five on bilateral upper limbs. The patient was advised to have computed tomography (CT), magnetic resonance imaging (MRI), and a bone density test to confirm the diagnosis of the condition. Investigations revealed a case of basilar invagination. But due to the financial burden, surgery couldn't be opted for; therefore, she opted for physiotherapy rehabilitation. The patient was managed with neuro-physiotherapy rehabilitation exercises like neural tissue stretch, which included nerve gliding and nerve stretching exercises, vestibular rehabilitation exercises, and gaze stabilization exercises. The strengthening of weakened muscles was done using Delorme's technique. Cervical traction, electrotherapy, and moist heat modalities like interferential therapy and hydrocollator packs were given. It also included deep breathing exercises like diaphragmatic breathing and thoracic expansion exercises. The exercise was planned according to the frequency, intensity, time, and type (FITT) principle. Frequency: five days/week; intensity: slow to moderate pace with rest intervals; time: 60 minutes/day; type of exercise: strength training along with other exercises for a total of thirty days. The patient was able to resume her job after receiving physiotherapy rehabilitation, which played a pivotal role in decreasing her symptoms.

An Integrated Physical Therapy Using Spencer's Technique in the Rehabilitation of a Patient With a Frozen Shoulder: A Case Report.

A frozen shoulder is a painful condition characterized by pain and stiffness. In frozen shoulder, the capsule of the joint gets inflamed, leading to pain that limits shoulder movement and thereby affects shoulder functions. There are three stages of frozen shoulder, and the symptoms differ according to the stage. Physiotherapy plays an important role in the management of a frozen shoulder. The Spencer technique is a seven-step technique that is used to treat shoulder movement restrictions. In this case report, we present the case of a 57-year-old male shopkeeper by occupation with a right frozen shoulder with complaints of pain and stiffness around the shoulder region and reduced range of motion (ROM) for more than six weeks. Physiotherapy rehabilitation was given to the patient using Spencer's technique along with standard management for three weeks. Significant improvement in range of motion, decrease in pain, and functional disability, i.e., shoulder pain and disability index (SPADI), were seen post-rehabilitation and were sustained when evaluated at the end of the second, third, and sixth months.

Handwriting Evaluation in School-Aged Children With Developmental Coordination Disorder: A Literature Review.

Despite widespread computer use, legible handwriting remains an important common life skill that requires more attention from schools and health professionals. Importantly, instructors and parents typically attribute the difficulties to laziness or a lack of effort, causing the youngster anger and disappointment. Handwriting issues are a public health concern in terms of both prevalence and consequences. Writing is a tough and diverse activity that requires cognitive, perceptual-motor, mental, and emotional talents. It is largely a motor process involving an effective level of motor organization that results in exact movement synchronization. Handwriting problems have been connected to developmental disorders such as developmental coordination disorder. For the affected youngsters, forming letters takes more work, and the kid may forget what he or she planned to write. School children's primary handwriting issues include illegible writing, slow handwriting, and strained writing. Handwriting problems may lead to scholastic underachievement and low self-esteem. Because of this complication, some school-aged children develop handwriting difficulties, which cause psychological distress and learning impairments. In the treatment of children with bad handwriting, the therapeutic intervention has been demonstrated to be successful. We aimed to determine how efficient tools and scales are which assess handwriting in school-aged children having developmental coordination disorder. Keyword searches were conducted on Google Scholar and PubMed, yielding 45 results, eight of which met the inclusion requirements. We concluded that there are a lot of scales and tools to date but no scale focuses on the temporal and spatial parameters for handwriting evaluation.

Appraisal of the Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Methods to Optimize Balance and Gait in an Eight-Year-Old Child.

Among the different variants of cerebral palsy (CP), spastic diplegia has a greater frequency than the other variants, with each subtype having a diverse clinical presentation. Pelvic asymmetry is observed frequently in children with spastic diplegia which influences the functional abilities of the child such as balancing abilities and independent walking. Currently, physical therapists tackle this condition through numerous strategies of treatment, with each treatment strategy having its own significance. This case report emphasizes the effectiveness of pelvic proprioceptive neuromuscular facilitation (PNF) techniques in optimizing the balance and gait parameters in an eight-year-old female child who presented with spastic diplegia. The child came into the outpatient Department of Neuro Physiotherapy with complaints of delay in attaining milestones according to her age as well as her inability to balance and walk on her toes. History revealed that there was a delayed cry pointing toward birth asphyxia and the linkage of birth asphyxia in the emergence of CP. Pelvic PNF has a beneficial impact on optimizing trunk control and stability. This research presents evidence that pelvic PNF optimizes the balancing capacities and gait parameters and rectifies the malalignment of the pelvis in children with spastic diplegia. The findings of this case report prove that pelvic malalignment which influences the balance and walking abilities of the child can be rectified and tackled with pelvic PNF techniques.

Bilateral Lower Limb Training for Post-stroke Survivors: A Bibliometric Analysis.

Stroke is one of the most disabling conditions affecting the middle-aged population all around the world. This study aims to explore the rehabilitation of stroke patients using bibliometric analysis, which includes statistical analysis of recent articles, books, and other kinds of publications, to assess scientific output and determine the significance of scientific investigations in terms of both quality and quantity. In this study, an analysis of global trends in research in bilateral lower limb training for training balance and walking for patients in the subacute stage post-stroke between 1988 and 2021 was done. All the articles were obtained from PubMed databases. CiteSpace software was used to analyze the relationship between publications and country, journals, institutions, authors, references, and the keywords used. A total of 160 publications were included in the analysis. There was a tremendous increase in the research of physiotherapy intervention in patients who had residual disability post-stroke with a publication rate of 7.1 articles per year of publications. The use of the sophisticated PubMed database to extract articles allowed for a thorough and powerful bibliometric analysis of stroke rehabilitation research published between 1988 and 2020. In general, the number of studies on bilateral training has increased in recent decades. This historical overview of rehabilitation for post-stroke survivors will serve as a valuable starting point for future study into possible collaborators, focus issues, and trends. This bibliometric analysis highlights the potential value of exercise therapy for stroke survivors in creating more effective hemiplegia rehabilitation programs. This research may encourage the use of strengthening in the therapeutic therapy of hemiplegia balance. The groundwork will be laid for future research on strengthening stroke to be organized and given top priority.

Efficacy of Bilateral Lower-Limb Training Over Unilateral Lower-Limb Training To Reeducate Balance and Walking in Post-Stroke Survivors: A Randomized Clinical Trial.

Background and objective While designing the rehabilitation regime of a hemiplegic patient, most physiotherapists focus on the affected/hemiparetic side. The less affected/unaffected side remains unused and loses its properties, i.e., muscle strength, girth, balance, and gait, thus causing deconditioning effects in patients' overall rehabilitation. To enhance the recovery process, the focus should be drawn to training both sides equally to fasten the recovery process. The rationale behind designing this study was to maintain the integrity of the unaffected side along with rehabilitation of the affected side in hemiplegic patients. Many proven studies focus on bimanual upper-limb training in post-stroke survivors, but there is a lack of literature regarding the same in the lower limbs. This clinical trial was designed to study the effect of bilateral lower-limb training over unilateral lower-limb training on balance and walking in post-stroke survivors. Methods 40 hemiplegic patients were selected and randomly divided into two groups: Group A (unilateral training group (UTG)) and Group B (bilateral training group (BTG)). Patients in Group A underwent approach-oriented training using the motor relearning program (MRP) and proprioceptive neuromuscular facilitation (PNF) for the affected side, while those in Group B underwent strength training for the lower-limb muscles using DeLorme's principle for the unaffected side and approach-oriented training using the MRP and PNF for the affected side for a period of six weeks, five days per week. A strengthening regimen was designed for the unaffected side, considering the frequency, intensity, time, and type (FITTs) principle provided by the American College of Sports Medicine (ACSM). The static and dynamic balance along with gait parameters were measured using the functional reach test (FRT), one-leg stance test (OLST), Berg balance scale (BBS), Dynamic Gait Index (DGI), gait parameters (stride length, gait velocity, and cadence), and Brunnstrom recovery stages (BRS) at the baseline and post rehabilitation. Results Both groups significantly improved following therapy (p<0.05). Group B showed more significant results both statistically and clinically. The enhancement in the FRT (2.25, p<0.03), OLST (5.12. p<0.0001), BBS (0.68, p<0.020), and DGI (1.70, p<0.030) scores indicated improvement in static and dynamic balance in the two groups. Patients showed improvement in the stereotyped sequence of movements indicating recovery on the BRS (4.62, p<0.0001). The overall gait parameters in patients, i.e., gait velocity (6.78, p<0.0001), stride length (3.59, p<0.001) and cadence (6.15, p<0.0001), improved post rehabilitation. Conclusion The results of this study showed that the BTG had positive impacts on the postural balance and walking capacities of subacute hemiparetic stroke patients, promoting early recovery in comparison to the UTG. This study also helped to design a strengthening protocol for the unaffected side according to DeLorme's principle in line with the FITTs principle.

Physiotherapy for Multiple Sclerosis Patients From Early to Transition Phase: A Scoping Review.

Multiple sclerosis (MS) is a chronic neurological disease that has an impact when they are at the most susceptible aspects of personal, professional, and social development. MS affects about 2.2 million individuals worldwide, with the majority of individuals experiencing relapses regularly. The progression of the disease's complex nature, the challenges in selecting the appropriate intervention, and a multitude of symptoms necessitate a systematic approach to the individual that includes both pharmacology and neurorehabilitation. Kinesiotherapy, exercise rehabilitation, massage, and hydrotherapy are all forms of physiotherapy that are used as part of rehabilitation. Physical exercise will mitigate the potential effects of akinesia and so enhance the functioning capacities of all bodily systems, regardless of the severity of the illness. An early examination by a physical therapist who is familiar with MS is advised to develop a customized training and/or lifestyle physical exercise program. Although hospital-based rehabilitation programs appear to have a higher impact, numerous studies have found that home-based rehabilitation is helpful. The constraint imposed by COVID-19 has an influence on the well-being of persons with multiple sclerosis. People with MS would be particularly affected, since they might be considered an at-risk group for serious COVID-19 in a variety of ways, and MS health-related data requirements increased significantly.

Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation on Balance and Gait Parameters in Children With Spastic Diplegia.

Background  Among several variants of Cerebral Palsy, Spastic Diplegic is encountered most commonly in clinical setups. A majority of children with Spastic Diplegia manifest themselves with a disturbance in the geometrical orientation of their pelvis, which imposes an effect on their functional capabilities like walking with independence. This research had an emphasis on the extraction of the efficacy of Pelvic Proprioceptive Neuromuscular Facilitation (PNF) Techniques on Balance and Gait Parameters in children suffering from Spastic Diplegia. Method Participants included in the study were between the age groups of 8 to 12 years who were diagnosed with Spastic Diplegia with an independent sitting and walking ability and who are coming in stages I to III according to Gross Motor Function Classification System. Subjects in group A were given Pelvic PNF techniques for 15 minutes on both sides along with Task-Oriented training for 30 minutes, six days a week and continuously for four weeks, while the subjects in group B were given only Task-Oriented activity for the same duration. The pre- and post-treatment assessments of all 40 subjects were gathered using the Paediatric Balance Scale, Palpation Meter device, and Gait Parameters. Results The study included 40 participants, which were segregated into two groups of 20 subjects in each group. Group A received Pelvic Proprioceptive Neuromuscular Facilitation with Task-Oriented Training, and group B received only Task-Oriented training activities. The contrast of pre- and post-treatment findings of both the groups revealed that group A reported a significant improvement in their outcomes (P>0.0001). Conclusion  The present study, which included 40 subjects, has generated evidence regarding the efficacy of Pelvic PNF on Balance and Gait Parameters in children with Spastic Diplegia.