Mobile Health (mHealth) Applications for Stroke Rehabilitation: A mini review.

Mobile Health (mHealth) applications are transforming stroke rehabilitation, through personalized care and datadriven insights. These applications employ AI-driven algorithms, tele-rehabilitation, wearable technologies, and gamification to enhance recovery process. The objective of this mini review is to explore the transformative role of Mobile Health (mHealth) applications in stroke rehabilitation, highlighting its capacity to transcend geographical barriers and establish extensive support networks connecting stroke survivors, caregivers, and healthcare professionals. Particularly in developing countries like Pakistan, where healthcare resources may be limited, mHealth offers a viable solution to bridge the gap in stroke care. By facilitating access to rehabilitation services, mHealth can significantly improve outcomes for stroke survivors in these regions. This integration of mobile technology with stroke rehabilitation not only promises personalized and more effective rehabilitation but also presents a unique blend of technology and compassion. This evolution in healthcare holds the potential to redefine stroke recovery, marking a significant milestone in the journey towards more inclusive, efficient, and compassionate care solutions.

Association Between Hip Flexor Tightness And Lumbar Instability In Adults.

The study aimed to explore the association between hip flexors tightness and lumbar instability in adults. The study design was correlational and 64 subjects of both genders (male and female) with age range from 20 to 50 years were selected with a history of low back pain (LBP) with or without referred pain. Two examiners were assigned for application of the Modified Thomas Test (MTT) for hip flexors tightness and lumbar prone Instability Test (LPIT) and Prone Lumbar Extension Tests (PLET) for lumbar instabilities. The numeric pain rating scale (NPRS) was used for pain assessment. The two examiners were not aware of each other's findings. The lambda value 0.238 which shows there is a weak association between MTT and PLET. The Cramer's V value 0.179 also shows a weak relationship between MTT and LPIT. This study observed that there is a weak association between tight hip flexors and lumbar instability.

Task Oriented Training For Stroke Rehabilitation: A Mini Review.

Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT.

Association of muscles length and strength with balance and functional status among children with diplegic spastic cerebral palsy.

OBJECTIVE: To determine the correlation of muscle length and muscle strength with balance and functional status among children with diplegic spastic cerebral palsy. METHODS: The cross-sectional study was conducted from February to July 2021 at the Physical Therapy Department of Chal Foundation and Fatima Physiotherapy Centre, Swabi, Pakistan, and comprised children aged 4-12 years with diplegic spastic cerebral palsy. The strength of back and lower limb muscles was assessed through manual muscles testing. Lower limb muscle's length, indicating tightness, was assessed using goniometer. Paediatric balance scale and gross motor function measure scale-88 were used to assess balance and gross motor function. Data was analysed using SPSS 23. RESULTS: Of the 83 subjects, 47(56.6%) were boys and 36(43.4%) were girls. The overall mean age was 7.31±2.02 years, mean weight was 19.71±5.45kg, mean height was 105.5±14cm and mean body mass index was 17.32±1.64 kg/m2. There was a positive and significant correlation of all the lower limb muscles' strength with balance (p<0.01) and functional status (p<0.01). The correlation between the tightness of muscles and balance was significant and negative for all lower limb muscles (p<0.005). The correlation between the muscles' tightness and functional status was negative and significant for all lower limb muscles (p<0.005). CONCLUSIONS: Good muscle strength and appropriate flexibility of lower limb muscles enhanced functional status and good balance in children with diplegic spastic cerebral palsy.

Role of Vitalstim® In The Management Of Patients With Dysphagia: A MiniReview.

Dysphagia defined as difficulty in swallowing, can result from multiple causes including, Stroke, head injury, Alzheimer, Dementia, Muscular dystrophy, Cerebral Palsy etc. It is associated with neuro-muscular impairments in different age groups. VitalStim® therapy is a relatively new approach to treat dysphagia. It provides neuromuscular electrical stimulation (NMES) of the involved muscles to improve the function of swallowing. This review summarizes the usefulness of VitalStim® in dysphagia, and barriers in its use in Pakistan.

Overview of gait rehabilitation in stroke.

Stroke is the 2nd leading cause of death globally after ischaemic heart disease and is expected to rise more by 2030. The estimated incidence of stroke in Pakistan is about 250/100,000 individuals. Difficulty in walking is present in approximately 80% of stroke survivors. About a quarter of stroke survivors, even after receiving rehabilitation have residual gait impairments requiring assistance in activities of daily life. Almost half of stroke patients after being discharged will have episodes of fall, with majority of these falls occurring in activities like "turning". Gait is one of the key features to participate in community and occupational activities. Therefore, appropriate gait rehabilitation post stroke is crucial for functional independence and community ambulation. There are many approaches to gait rehabilitation based on different models of motor physiology and disease. Augmenting conventional therapies with novel techniques such as utilization of electromechanical means have improved gait rehabilitation in improving functions. The usage of technology in rehabilitation of patients with neurological deficits, is still novel in Pakistan. This review provides an overview of advancements in neurological and gait rehabilitation post stroke.

The emerging role of virtual reality training in rehabilitation.

Virtual reality (VR) uses computer-generated simulations to create a virtual environment for users which appears, sounds, and feels like real-life objects and events. The use of VR in rehabilitation is relatively new and has demonstrated to be an effective tool in achieving desired clinical outcomes by active engagement of participants. Over the past few years, the use of VR in rehabilitation has rapidly increased because of its advantages over traditional rehabilitation techniques. These include better patient adherence to the rehabilitation protocols with high levels of engagement and motivation. This review summarises the available evidence on the role of VR in rehabilitation, its effects, and scope across different clinical conditions and outcomes. We also describe the current status of VR utilization in rehabilitation settings across Pakistan and highlight the need for further research.

Comparison of SAME verses CIMT on upper-limb functions in chronic stroke: A pilot randomized control trial.

OBJECTIVE: To compare the effects of Same Arm Movement Therapy versus Constraint Induced Movement Therapy in improving upper-limb functions in patients of chronic stroke. METHODS: The pilot, assessor-blind, randomised control trial was conducted from February to September 2020 at the Spine and Physiotherapy Rehab Centre, Riphah Rehabilitation Centre, Lahore, Pakistan, and comprised patients of either gender aged 30-60 years having any type of stroke for a minimum 3 months. They were randomised into group A which received same arm movement therapy for 8 weeks of mental rehearsal of upper limb movements during 45min supervised sessions three times a week and structured independent sessions twice a week, and group B which received constrain induced movement therapy for eight weeks of daily intensive training of the affected extremity for two hours per day, five days per week for eight weeks in association with restriction of the non-affected extremity for 10 hours a day. Measurements were taken at baseline and post-intervention. Data was analysed using SPSS 21. RESULTS: Of the 22 patients, 5(22.7%) were male and 17(77.3%) were female. The average age in group A was 54.91±5.89 years compared to 53.18±6.61 years in group B. All 22(100%) patients had ischaemic stroke. Intragroup comparisons showed significant progress in both groups (p<0.05), but intergroup comparisons showed non-significant differences (p>0.05). CONCLUSIONS: Both the study interventions had similar effect on upper limb functions among chronic stroke patients. RCT: Iranian Registry of Clinical Trials: RCT20200620047848N1 https://www.irct.ir/trial/49054.

Technological advancements in stroke rehabilitation.

Early, coordinated, and multidisciplinary rehabilitation plays a major part in motor recovery after stroke. The conventional stroke rehabilitation primarily includes physical therapy, occupational therapy, and speech therapy. However, with these conventional methods, many stroke survivors still have a residual functional disability which impairs their ability to perform activities of daily living. This could be attributed to the insufficient therapy dose, low engagement and motivation of the patient, and lack of objective feedback to achieve significant improvements in function. Various technology-based stroke rehabilitation interventions have been developed in the last few decades which have shown promising results in improving stroke patients' functional mobility and independence. The use of technology promotes repetitive, task-specific training, active engagement of patients, integrating constructive and concurrent feedback, and accurately measuring functional improvement. This review summarizes the important technological advances in stroke rehabilitation, including exergames, telerehabilitation, robotic-assisted systems, virtual and augmented reality, wearable sensors, and smartphone applications.

Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial.

BACKGROUND: The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy. METHODS: It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI. RESULTS: Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the "bodily pain" domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences. CONCLUSIONS: The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy. TRIAL REGISTRATION: This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 ( ClinicalTrials.gov Identifier) (Date: 26/02/2020).

Task-oriented training and exer-gaming for improving mobility after stroke: A randomized trial.

OBJECTIVE: To evaluate the effects of task-oriented training and to compare it with virtual reality training on the mobility, physical performance and balance in stroke patients. METHODS: The randomised controlled trial was conducted from January 2016 to March 2017 at the Physical Rehabilitation Department of Pakistan Railways General Hospital, Rawalpindi, Pakistan, and comprised patients 40-70 years with stroke history of at least 3 months who had the ability to stand unaided. The subjects were randomised into virtual reality training group A and task-oriented training group B. Task oriented training was provided for 3 days per week over 8 weeks to both groups with each session lasting 40-45 minutes, while additional 15-20 minutes of exer-gaming was provided only to group A. Fugl-Meyer Assessment-Lower Extremity, Berg Balance Test, Timed Up and Go Test and Dynamic Gait Index were used for assessment which was done at baseline, and at 2, 4, 6 and 8 weeks of training. Data was analysed using SPSS 21. RESULTS: Of the 52 subjects, there were 26(50%) in each of the two groups. The overall sample had 36(69.2%) males and 16(30.7%) females. Group A showed significant difference in Fugl-Meyer Assessment-Lower Extremity and Berg Balance Test scores at 04 weeks of training compared to group B (p<0.05). Timed Up and Go Test significantly improved in group A at 6 weeks (p<0.05). Both groups showed significant improvement in Dynamic Gait Index after 8 weeks of training (p>0.05). CONCLUSIONS: Virtual reality combined with task-oriented training improved the physical performance, mobility and balance outcome in stroke patients. However, virtual reality and task-oriented trainings had similar effect on gait performance of the patients.

Exer-gaming reduces fall risk and improves mobility after stroke.

The current study evaluated the effect of virtual reality based balance training in 30 stroke patients recruited via purposive sampling technique for a clinical trial. Sealed envelope method was used to randomly allocate patients into two groups, i.e. Exer-gaming group (EGG) (n=15) and traditional training (TBT) group (n=15). Patients ranging in age from 50 to 60 years were included using Modified Rankin Scale (MRS). Patients with cognitive deficits, severe physical impairments, contractures, inability to perform tasks, complications of the joint that affected movement, history of recent fracture, arthritis and those on drugs that could affect their physical function were excluded. Data was collected using Berg Balance Scale (BBS) and Timed Up & Go Test (TUG). Significant improvement was observed in the exer-gaming training group after completing intervention (P<0.001). Exer-gaming appears to be more effective in improving functional level, mobility and balance in stroke patients. The study also suggests that exer-gaming further provides dynamic environment for stroke patients, thereby improving dynamic balance and mobility.

Progressive resistance training improving gait performance and mobility in acute and chronic stroke patients.

Stroke, a neurological disorder, leads to long-term disability thereby greatly affecting gait and mobility. The purpose of the current study was to investigate the effects of progressive resistance training in both acute and chronic stroke patients. A quasi interventional study was designed and 46 stroke patients were recruited through convenience sampling technique. Sample size was calculated using epi-tool. Patients who had cognitive problems, balance impairments and contractures were excluded from the study. The study was conducted from January to June 2018, at Rafsan Rehab & Research Centre, Peshawar. Progressive resistance exercises starting at 50 % of one repetition maximum (RM) were performed three days/week and for a total duration of nine weeks. Blind assessor measured readings at baseline and after nine weeks. Gait dynamic index (GDI), Six-Meter Walk Test (SMWT) and Five Times Sit-to-Stand (FTSTS) tools were used to collect the required data. The data was analysed at baseline and after nine weeks on SPSS-20. After nine weeks of intervention significant improvement was recorded in patients on GDI (p<0.001), SMWT score (P<0.001) and FTSTS (p<0.001). Progressive resistance training improves mobility limitations and gait in both acute and chronic stroke patients.

Effects of structured exercise regime on lipid profile and renal function tests in gestational diabetes mellitus patients:A pilot study.

NOTE OF CONCERN: Article published in Journal of Pakistan Medical Association J Pak Med Assoc.February 2021, No. 2-A,Volume 72 Pages 505-507. This editorial expression of concern serves to notify readers that the Editorial Board has identified discernible weaknesses in the study design, statistical concerns and conclusion drawn regarding this previously published article, titled: "Effects of structured exercise regime on lipid profile and renal function tests in gestational diabetes mellitus patients-A pilot study" J Pak Med Assoc. Vol. 71, No. 2-A, February 2021pages 505-507. The Editorial Board has determined that : 1. The article did not discuss the feasibility of the pilot study, instead attempted to draw inference from the analytical outcomes, which does not allow readers to interpret the desired implications correctly. 2. The statistical methods applied were not at par and did not use the baseline data. The authors did not make full use of the data to add to the scientific weightage of the study, which could have been reported in the text. 3. The conclusion only points towards the positive impacts on serum markers for diabetes mellitus and renal functions. Considering the very small sample size used, this is an unjustified extrapolation. The authors did not attempt to mention the feasibility of the whole process, including participants' willingness, management, and resources that should have been assessed and reported to benefit the planning of the full-scale RCT. The editorial board of JPMA decided to publish this editorial expression of concern when we were made aware of deficiencies in the published article so that future researchers can plan their work on better scientific footings OBJECTIVE: To determine the effects of structured exercise regime on biochemical markers of patients of gestational diabetes mellitus during the third trimester. METHODS: The two-arm pilot study was conducted at the Fauji Foundation Hospital, Rawalpindi, Pakistan, from March to July 2019, and comprised women aged 20-40 years with gestational age >20 weeks who were diagnosed with gestational diabetes mellitus and who were able to do 6min walk test under severity level on the 0-10 Borg scale. The subjects were randomized into two groups using the sealed envelope method. The intervention group received 5 weeks of structured exercise programme. including aerobics, stabilisation and pelvic floor muscle training, while the control group only received postural education. Data was noted at baseline and after intervention, and was analysed using SPSS 20. RESULTS: Of the 16 subjects, there were 8(50%) in each of the two groups. The mean age was 31.5±4.17 years in the interventional group and it was 35.0±6.30 years in the control group. Serum low-density lipoprotein and serum creatinine showed significant differences between the groups (p<0.05), while the rest of markers were non-significant (p>0.05). CONCLUSIONS: Structured exercise regime was found to have a positive effect in reducing serum low-density lipoprotein and serum creatinine levels in gestational diabetes mellitus during the third trimester.

A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer.

Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; P = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [-0.97 to 2.66]; P = .36), hospital stay (WMD = 0.01 [-0.19 to 0.20]; P = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; P = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; P = .72). Skin incision was shorter in SILS CME group (WMD = -3.02 [-3.25 to -2.80]; P < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = -0.21 [-0.50 to 0.09]; P = .17) or day 2 (SMD = 0.16 [-0.52 to 0.84]; P = .64). Conclusions. SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.

Effects of structured exercise regime on Glycosylated Hemoglobin and C reactive protein in patients with Gestational Diabetes Mellitus - A randomized controlled trial.

OBJECTIVES: To evaluate the effects of structured exercise regime on Glycosylated hemoglobin and C reactive protein in patients with gestational diabetes mellitus. METHODS: This two arm parallel randomized controlled trial was conducted at Fauji Foundation Hospital, Rawalpindi from November 2018 till December 2019 on the 54 diagnosed gestational diabetes mellitus patients (Dropped out=4 Analyzed= 50) with age 20 to 40 years and gestational age from 20 to 36 weeks. Selection was done via convenient sampling technique and randomized into two groups (n=25) by sealed envelope method. Structured exercise regime group received combination of moderate intensity aerobics, stabilization and pelvic floor muscles exercises twice a week for 5 weeks (40 min per session) along with dietary and medical interventions while control group received only medical and dietary interventions with postural education. Demographics, glycosylated hemoglobin and C reactive protein were recorded at baseline then after 5 weeks of intervention. Analysis was done by SPSS 20. RESULTS: Mean age was 35.92 ± 5.24 years in control group while 34.36 ± 5.21 years in interventional group. Between group analysis for HbA1c showed no significant difference at base line (p >0.05) but showed significant difference (p <0.05) after five weeks' interventions. Similarly, for C reactive protein both groups showed no significant difference (p >0.05) at baseline but after five weeks of interventions showed significant difference (p<0.05). CONCLUSION: Structured exercise regime helps in reducing values of glycosylated hemoglobin and C reactive protein in patients with gestational diabetes mellitus.