ICU-acquired weakness: A multicentre survey of knowledge among ICU clinicians in South-Western Nigeria.

BACKGROUND: Knowledge of ICU clinicians about Intensive Care Unit Acquired Weakness (ICU-AW) is a vital step in implementing prevention strategies. AIM OF STUDY: The purpose of this study was to investigate the level of knowledge of ICU clinicians in teaching hospitals in Southwest Nigeria about ICU-AW. METHODS: ICU clinicians were surveyed using a self-administered questionnaire to obtain data on knowledge about ICUAW. Data were summarized as frequency and percentages, mean and standard deviation using SPSS version 20. RESULTS: Total of 134 ICU clinicians (56 anesthetists, 35 physiotherapists, and 43 nurses) responded to the questionnaire, of which 100 were aware of ICUAW. Three of the 100 correctly identified ICU-AW as a neuromuscular disease. Totally, 40% correctly indicated Medical Research Council Scoring Scale as a diagnostic tool for ICU-AW. Severe sepsis and prolonged mechanical ventilation were the two highest identified risk factors for ICU-AW. However, only 35% of respondents were able to identify either use of aminoglycosides, and prolonged use of vasopressors as risk factors for ICUAW. Almost half (49%) reported having methods of managing ICUAW at their institution. CONCLUSION: Though awareness about Intensive care unit-acquired weakness (ICUAW) among clinicians in teaching hospitals in the Southwestern Nigeria is high, but knowledge about diagnosis and classification is low. This highlights the need for specialized training of ICU clinicians about ICUAW to enhance prevention and early detection.

Psychosocial impact of wheelchair usage on individuals with mobility disability in Ibadan, Nigeria.

BACKGROUND: Wheelchairs provide individuals with mobility impairments opportunity for independent living within their environment. However, using this device may have psychosocial impacts with consequent influence on the quality of life of the users. The psychosocial impact of wheelchair usage among individuals with mobility disability in a Nigerian community was investigated. METHODS: The study is a descriptive cross-sectional survey. People who have been independent users of wheelchair for a minimum of six months prior to the study were recruited from centres for people with disabilities in Ibadan, Nigeria into the study. A profile of their use of the device was documented and the psychosocial impact of wheelchair was assessed using the Psychosocial Impact ofAssistive Devices Scale. Data were analysed using descriptive and inferential statistics at p = 0.05. RESULTS: Sixty consenting individuals with mobility disability participated in this study. Their mean age was 38.7 +/- 14.1 years. Majority (90%) were manual wheelchair users and two-thirds (63.3%) had been using the wheelchair for < or = five years. Approximately a third of the participants use their wheelchairs occasionally. There was no significant difference (p=0.26) in the psychosocial impact of wheelchair usage between male and female users. CONCLUSION: The psychosocial impact of wheelchair was similar between male and female users. However, the impact was higher on the self-esteem of male than female users and lower on their competence than that of their female counterparts. This may be due to stigmatization or a culturally-related unwillingness of men in our environment to be dependent on others.

Backpack-related musculoskeletal symptoms among Nigerian secondary school students.

Musculoskeletal discomfort in schoolchildren is significantly related to the weight and mode of carrying backpack to school. Prevalence and patterns of musculoskeletal discomfort among Nigerian secondary school students carrying backpack was investigated. Systematic sampling technique was used in the selection of the participating junior secondary schools for this study. Participants comprised 1,785 students aged 10-15 years. Standardised Nordic musculoskeletal questionnaire was used to collect information on musculoskeletal pain. Backpack weight and participants' body weight were measured using a weighing scale. The visual analogue scale was used to assess pain intensity. Gender differences in backpack weight, backpack percentage and musculoskeletal discomfort were studied using Mann-Whitney U test; Kruskal-Wallis test was used to study the influence of backpack carrying style on musculoskeletal discomfort; and Spearman rho correlation to determine the relationships between backpack weight, backpack to body weight ratio, age and pain intensity. There were 882 boys and 903 girls recruited into the study. Shoulder pain was the most prevalent discomfort (63.5 %), and pain was significantly higher in girls (p = 0.013). There were weak relationships between pain intensity, body weight and backpack to body weight ratio (r range 0.433-0.442; p < 0.001), and a weak negative relationship between pain intensity and age [r = -0.135; p < 0.001; 95 % confidence interval (CI) -0.168, -0.075]. There was a strong relationship between backpack weight and age (r = 0.892; p < 0.001; 95 % CI -0.129, -0.013); however, there was a weak relationship between backpack weight and body weight (r = 0.136; p < 0.001). Prevalence of shoulder pain was high, particularly among the girls, in this sample. We suggest that factors other than the weight of backpack may predispose to musculoskeletal pain. Parents, teachers and clinicians can influence the mode of carrying backpack by secondary school students.

Acute effects of cold and muscle vibration on maximal grip strength and muscle endurance in normal subjects.

The objective of this study was to compare the acute effects of 10 minutes cold application and 50Hz, 90 seconds vibration of forearm muscles on maximum grip strength and muscle endurance in apparently healthy young adults. This within-subject factorial research study recruited eighty-nine subjects (49 males and 40 males) using a sample of convenience. Baseline maximum grip strength and endurance index were measured using a Jamar dynamometer. Cold and muscle vibration were applied within 48 hours interval to the forearm muscles of the subjects. Their grip strength and endurance index were measured; immediately, 5, and 10 minutes post-application of either stimuli. Data were analysed using independent t-test and one-way analysis of variance at 0.05 alpha. Results showed that neither vibration (P>0.05) nor cold (P>0.05) produced any significant effect on the maximum grip strength and the grip endurance at 5 and 10 minutes post application. The subjects however recorded significantly higher endurance index immediately post cold than they did immediately post vibration (P<0.05). We concluded that grip endurance was enhanced more by cold application than by muscle vibration. Cold rather than vibration may therefore be used to facilitate grip endurance during hand rehabilitation.

Physical characteristics as predictors of quadriceps muscle isometric strength: a pilot study.

This one-group experimental study was carried out to investigate the relationship between isometric strength of quadriceps femoris muscle group and physical characteristics of subjects namely: age; weight; and height. Prediction equations were also derived for quadriceps isometric strength from these physical characteristics. Fifty volunteer, right-legged healthy normal male subjects participated in the study. They were aged between 19 and 27 years. The subjects had no previous history of neuromuscular and skeletal injuries to the lower limbs. Their ages, height and weight were measured in years, centimeters and kilograms, respectively. Quadriceps isometric strength was measured using an adapted cable tensiometer (ACT) and recorded in kilogramforce (kgf). Pearson's product correlation co-efficient (r) was used to study the relationship between quadriceps strength and each of age, height and weight. Linear and multiple regression analyses were also carried out. The result showed a high and positive Pearson's moment correlation coefficient (r) between quadriceps isometric strength and each of weight and height. A positive but low correlation (r) was also found between age and quadriceps isometric strength. Prediction equations were also derived from the linear and regression analyses. The study concluded that there was linear relationship between the physical characteristics and quadriceps isometric strength. It was recommended that the prediction equation be employed to estimate quadriceps strength while setting muscle strengthening goals in the clinics during medical rehabilitation for patients within the age range used in this study.

Electrical (faradic) stimulation versus active mobilization exercise in the physical management of post-surgical temporomandibular joint hypomobility.

This clinical study compared the efficacy of faradic stimulation and active mobilization exercises in the physical management of patients with post-surgical immobilization of the temporomandibular joint (TMJ) resulting in hypomobility of the joint. Eight volunteer dental patients with post-surgical immobilization TMJ hypomobility at the University College Hospital (U.C.H.), Ibadan, Nigeria participated in the study. Duration of TMJ immobilization was between 6 and 10 weeks (mean 7.13 +/- 1.55). Patients were alternately assigned to two groups as they became available. Patients in group A received mild infra-red radiation to the TMJ region and faradic stimulation to the muscles that move the joint while patients in group B had mild infra-red radiation and TMJ mobilization exercises. Treatment continued until pain relief and full range of the TMJ were attained. However after three treatment sessions, attendance became irregular because the patients were satisfied with their recovery. Pain perception was measured using the visual analogue scale. Interincisal opening was measured using a pair of mathematical set divider and a measuring ruler. The results showed that both faradic stimulation and exercises significantly improved the interincisal opening and pain perception although electrical stimulation improved mouth opening more significantly than active exercise.

Functional ability, community reintegration and participation restriction among community-dwelling female stroke survivors in Ibadan.

BACKGROUND: Stroke is not gender-discriminatory. Yet, the subject of stroke among females has apparently not received significant attention from clinical researchers. The consequences of stroke include functional and psychosocial sequelae which may cause disability, hinder community reintegration and restrict participation. The inter-relationships among functional ability, community reintegration and participation restriction of community-dwelling, female stroke survivors in Ibadan were assessed in this descriptive study. METHODS: Fifty-two community-dwelling female stroke survivors (mean age = 56.55±9.91 years) were surveyed using consecutive sampling technique. Their functional ability level was measured using the Functional Independence Measure (FIM) while London Handicap Scale (LHS) was used to assess their participation restriction. Data were analyzed using Spearman Rank Correlation Coefficient (rho) and Mann-Whitney U test at p = 0.05. RESULTS: Significantly positive correlations (p< 0.05) were found between functional ability and community reintegration (r = 0.54; p = 0.01) as well as between participation restriction and community reintegration (r = 0.34; p = 0.05). Individuals with left hemiplegia had significantly higher mean rank scores in functional ability (30.41) than those who had right hemiplegia (mean rank scores = 21.94). CONCLUSION: Functional ability which appears to be related to stroke laterality showed positive association with both community reintegration and participation restriction. This suggests that improving the functional ability of the stroke survivors may reduce participation restriction and enhance their reintegration into the community. A similar study which compares male and female stroke survivors in the same community is thus necessary.

Motor function recovery and quality of life among stroke survivors in Ibadan, Nigeria. A 6-month follow-up study.

AIM: There is paucity of longitudinal studies exploring motor recovery and quality of life (QoL) among Nigerian-African stroke survivors. This study assessed the trend of motor function and QoL as well as relationship between the two constructs among Nigerian stroke survivors over a period of 6 months. METHODS: Motor function and QoL of 16 (9 males and 7 females) consecutive stroke survivors (60.68+/-9.78 years) recruited from a Nigerian tertiary health facility in Ibadan were assessed within four weeks of stroke onset (baseline) and monthly for five consecutive months using the Modified Motor Assessment Scale (MMAS) and World Health Organization's WHOQoL BREF questionnaire respectively. Friedman's ANOVA was used to study the pattern of each construct across the study period, while relationship between the MMAS and WHOQoLBREF at the first and sixth month post-stroke was computed using Spearman's correlation coefficient at 0.05 alpha. RESULTS: The MMAS values of the participants increased significantly (P<0.05) particularly in the first three months and between the fifth and sixth month post-stroke. The WHOQoLBREF scores showed inconsistent increase and decrease over the study period; this was however not statistically significant (P>0.05). No significant correlation was observed between MMAS and WHOQoLBREF scores (P>0.05) however, both the psychological and environmental domains of the overall health item of the QoL showed significant correlation (P<0.05) with motor function at the 1st month post-stroke. CONCLUSIONS: Significant recovery of motor function occurred in the first 3 and between the 5th and 6th months after stroke. There was alternating improvement and decline in the QoL over the study period, this was however not statistically significant. Only the health item of QoL was associated with improved motor function in this sample. The overall implication is that motor function and QoL did not follow the same pattern during the 6 months follow-up.

Effects of walking with a cane on balance and social participation among community-dwelling post-stroke individuals.

AIM: Walking devices such as canes and frames are often prescribed to post-stroke individuals to enhance their balance and walking, and thus facilitate community reintegration and social participation. The aim of this study was to observe social participation and balance in post-stroke hemiparetic patients and compare the performance of those walking with a cane (AD group) and without a cane (WAD group). The relationships between cane usage and activity participation and balance were also studied. METHODS: In this ex post facto research study, balance and social participation were evaluated using the Berg Balance Scale (BBS) and the Craig Handicap Assessment and Reporting Technique (CHART) in 50 individuals with hemiparesis secondary to first incidence hemispheric stroke. The study included 25 AD subjects (mean age 59.88+/-12.04 years) and 25 WAD subjects (mean age 55.84+/-11.30 years) who were consecutively recruited from the physiotherapy units of Korle Bu Teaching Hospital (KBTH) and the 37 Military Hospital in Accra (Ghana). Before recruitment into the study, both groups of subjects were matched for age, height, weight, BBS and CHART scores at the point of discharge from the inpatient units of the two hospitals, the duration of stroke, and the duration of physiotherapy post-stroke. RESULTS: Mann-Whitney U statistics showed that the AD group had comparatively higher mean participation scores (U=22.37; P=0.00) and lower mean balance performance (BBS score U=30.68; P=0.00) than their WAD counterparts. Spearman's correlation coefficient also revealed a significant negative correlation between the BBS and CHART scores in both groups (AD rho=-0.063; P=0.00 and WAD rho=-0.037; P=0.05). CONCLUSION: These findings indicate that post-stroke individuals who used a cane to aid in walking had poorer balance and less social participation than their age-matched counterparts who walked unaided. As balance improved (higher BBS score), participation also improved (lower CHART score) in both groups. In spite of the small sample size, the outcome of this study suggests that prescription of a cane for a post-stroke individual should be carefully considered by the physiotherapist, especially if the focus of rehabilitation includes restoration of balance functions and social participation.

The Effects of Static Stretch Duration on the Flexibility of Hamstring Muscles

The effects of duration of a static stretching protocol (Intervention) on hamstrings tightness were evaluated.Sixty purposively sampled subjects with unilateral hamstring tightness that had no history of low back and lower extremity dysfunctions that necessitated medical intervention participated in the study. They were randomly assigned into one of 5 intervention and one control groups. Groups a, b, c, d, e subjects had their hamstrings passively stretched for 120, 90, 60, 30, and 15 seconds respectively, while group f served as control. This intervention was carried out on alternate days for 6 consecutive weeks. Knee extension deficit (KED) was measured for all groups at baseline, weekly and 7days post cessation of the intervention (carry-over). Data were analysed using one-way ANOVA and paired t-test at 0.05 alpha.Asignificant reduction (P<0.05) was observed in the KED of subjects in all the intervention groups across the 6 intervention weeks. There was no significant difference between the immediate post intervention and carry-over KED values (p>0.05). The study shows that statically stretching tight hamstrings for any duration between 15 and 120 seconds on alternate days for 6 weeks would significantly increase its flexibility. The effect was also sustained for up to 7 days post intervention