Multifactorial inspiratory muscle training and its impact on respiratory and functional parameters of patients with diabetic polyneuropathy-A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Diabetic polyneuropathy is a long-standing microvascular complication of diabetes that affects the postural control and functional mobility of patients. There are other microvascular complications, including pulmonary complications that reduce lung function. Multifactorial Inspiratory Muscle Training (IMT) can act as a home-based technique targeted to affect both these complications. This study aims to determine the effects of IMT on respiratory and functional parameters in diabetic polyneuropathy patients. METHODS: This is a Pre-Test Post-Test Randomized Controlled Trial (NCT#04947163) with 62 diabetic polyneuropathy patients. Each was randomly assigned to the IMT or sham-IMT group. Both the groups performed OTAGO exercises , with the sham-IMT group performing IMT at 15% of baseline maximal inspiratory pressure (MIP), whereas IMT were trained at 50% of baseline MIP as an initial intensity, which was increased as per the tolerance of patients. Both groups performed training for 12 weeks. The study investigated diaphragmatic strength, pulmonary function, functional capacity through 6MWT, 30s sit to stand test and anterior trunk muscle endurance tested through sit up test as outcome variables. Data was analysed on SPSS v26 at the significance level of 0.0.5. RESULTS: The IMT group significantly improved diaphragmatic strength, pulmonary function, 6MWT and anterior trunk muscle endurance when compared to the sham-IMT group. CONCLUSION: The study concluded that home-based IMT can improve pulmonary parameters including diaphragmatic strength and lung function as well as functional parameters including functional capacity in patients with diabetic polyneuropathy. The study was registered at ClinicalTrials.gov, NCT#04947163.

Does multifactorial inspiratory muscle training improve postural stability and quality of life of patients with diabetes in Pakistan? A randomised controlled trial.

OBJECTIVE: To determine the effects of multifactorial inspiratory muscle training (IMT) combined with Otago Exercise Programme (OEP) on balance and quality of life (QoL) in patients with diabetes. METHODS: Pretest-post-test randomised controlled trial. SETTING: Rehabilitation Department of Pakistan Railway General Hospital. PARTICIPANTS: 70 patients with diabetes were randomly assigned to experimental or placebo groups, out of which 59 patients completed the intervention. INTERVENTION: Patients in the experimental group performed OEP+IMT (at 50% of baseline maximum inspiratory pressure (MIP)) whereas the placebo group performed OEP+sham IMT (at 15% of MIP). Both groups exercised for 12 consecutive weeks. OUTCOME MEASURES: Outcome measures included nine variables: the Berg Balance Scale (BBS), the Biodex Postural Stability System (including postural stability test (Overall Stability Index, Anterior-Posterior Index and Mediolateral Index), fall risk test (FRT), Limits of Stability (LOS) test (time to complete test and direction control), Clinical Test of Sensory Interaction and Balance (CTSIB)) and the Audit of Diabetes Dependent Quality of Life questionnaire. RESULTS: Out of 59 patients who completed treatment, 37.1% were men and 62.9% were women with a mean age of 58.37±5.91 years. Results show significant interaction effects on BBS scores with the mean score improving from 41.87±2.61 to 49.16±2.50 in IMT versus sham IMT group with scores improving from 41.58±2.51 to 45.74±2.30. The IMT group significantly improved in dynamic balance tested through BBS (p=0.003), anticipatory balance through LOS test (p=0.003), reactive balance tested through FRT (p=0.04), direction control (p=0.03) and sensory integration through CTSIB test (p=0.04) when compared with the sham IMT group. While no significant changes (p>0.05) between groups were observed in QoL and static balance; significant changes (p<0.05) within group were observed in both groups in QoL and static balance. CONCLUSION: Additional research is necessary to understand the association between inspiratory muscle strength and balance, however, we demonstrated that a multifactorial IMT intervention should be used with patients with diabetes to improve balance, postural control and reduce fall risks. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT#04947163.

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.

Comparison of Nonimmersive Virtual Reality and Task-Oriented Circuit Training on Gait, Balance, and Cognition Among Elderly Population: A Single-Blind Randomized Control Trial.

Purpose: The purpose of this study was to determine the effects of nonimmersive virtual reality (VR) and task-oriented circuit training on gait, balance, cognitive domains, and quality of life among the elderly population. Methods: This is a single-blind randomized control trial in which 28 elderly individuals between 60 and 75 years were selected. The participants were divided into two groups, task-oriented circuit training and the other receiving nonimmersive VR treatment, with 14 participants in each group. To analyze the effects of both training on balance and gait time up and go test (TUGT), dynamic gait index (DGI), measures were used and for cognitive domains Montreal cognitive assessment (MoCA) scale was used. Short form 12 (SF-12) (along with two domains, Physical Component Summary and Mental Component Summary) was used for the measurement of quality of life. The treatment duration was 8 weeks for both groups. Both the pre-test and post-test readings were analyzed and compared. Results: The mean age of participants was 66.91 ± 3.79 years. Within-group comparison between the pre-test and post-test indicated that significant differences (P < 0.05) existed in all the outcome measures (TUGT, DGI, MoCA, and SF-12) in both groups. However, between-group comparison, significant differences were only found in TUGT and DGI in nonimmersive VR group. Conclusion: This study concluded that both interventions nonimmersive VR and task-oriented circuit training were beneficial for improving balance, gait, quality of life, and cognitive domains like memory, attention spans, executive functions, and so on in elderly population. However nonimmersive virtual reality training is a more effective, feasible, and safe alternative and can be proposed as a form of fall prevention exercise for the older adults. ClinicalTrials.gov Identifier: NCT05021432.

Effects of Constraint-Induced Movement Therapy and Application Time and Duration of Intervention for Lower Extremity in Stroke: A Systematic Review.

The primary aim of this review was to determine the effects of CIMT (constraint-induced movement therapy) on gait, balance, and motor functions of the lower extremity in stroke. The secondary aim was to determine the optimal dosage, application time, and duration of CIMT in the lower extremity in stroke. PubMed (1999-July 2021), Pedro (2000-December 2020), Google Scholar (1999-Febraury 2022), and Cochrane Library (2000-Febraury 2022) were searched in February 2022. The risk of bias was calculated through the criteria outlined in the (Cochrane-Handbook for Systematic-Reviews of Interventions). Eight RCTs were included in this review. CIMT was found to be effective in improving balance, gait, and motor functions of lower limbs; however, its superiority in comparison to the control group was not significant, no specific dosage was mentioned for lower limb CIMT as different studies used different durations and intensities of CIMT. Key Words: Cerebrovascular accident (CVA), Balance, Lower-extremity constraint-induced movement therapy (CIMT), Motor functions.

Comparison of a single session of tDCS on cerebellum vs. motor cortex in stroke patients: a randomized sham-controlled trial.

OBJECTIVE: The purpose of this study was to determine whether a single session of trans-cranial direct current stimulation (tDCS) of the cerebellum and M1 has any advantages over one another or sham stimulation in terms of balance, gait and lower limb function. METHODS: A total of 66 patients who had experienced their first ever stroke were recruited into three groups for this double-blinded, parallel, randomized, sham-controlled trial: cerebellar stimulation group (CbSG), M1 stimulation group (MSG) and sham stimulation group (SSG). A single session of anodal tDCS with an intensity of 2 mA for a duration of 20 min was administered in addition to gait and balance training based on virtual reality using an Xbox 360 with Kinect. Balance, gait, cognition and risk of fall were assessed using outcome measures before intervention (T0), immediately after intervention (T1) and an hour after intervention (T2). RESULTS: Across group analysis of all outcome measures showed statistically non-significant results (p > .05) except for Six Minute Walk Test (p value T0 = .003, p value T1 = .025, p value T2 = .016). The training effect difference showed a significant difference in balance, gait and cognition, as well as cerebral and cerebellar stimulation, in comparison to sham stimulation (p < .05). The risk of falls remained unaffected by any stimulation (p > .05). CONCLUSIONS: In addition to Xbox Kinect-based rehabilitation training, a single session of anodal tDCS to the M1 or cerebellum may be beneficial for improving lower limb function, balance and gait performance.

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.

Investigating symmetrical influence of economic expansion, oil price, and industrial production on trade deficit: a policy pathway toward three neighboring Asian states.

The intense objective of the present study is to investigate the symmetrical effectiveness of economic expansion, inflation rate, oil price, interest rate, and industrial production on trade deficit of the three neighboring states (China, Pakistan, and India). Westerlund bootstrap LM (Lagrange multiplier) panel co-integration test, Dumitrescu Herlin method, PMG-ARDL model, quantile regression, and quarterly data of last 15 years (2006Q1 to 2020Q4) have been utilized to envisage outcomes. Initial measurements validate the existence of stable co-integration and uni-directional causality among variables. Nevertheless, PMG-ARDL measures evaluates that in both long and short span of time, except industrial production all other regressors (economic expansion, inflation rate, oil price, and interest rate) positively influences the trade deficit in three neighboring states. Furthermore, robust estimates of quantile regression also authenticate the correctness of the above discuss relationship in study economies by evaluating positive (negative) impact of economic expansion, inflation rate, oil price, and interest rate (industrial production) on trade deficit. Thus, in policy pint of view, to lessen trade deficit hazard in studied economies, it is necessarily needed to encourage industrial production, replaced fossil fuel using outdated gadgets with advance green technology instruments, control inflation, and interest rate in single digit through strong budgetary and monetary policies and maintain economic expansion with appropriate and comprehensive taxation system.

Proposing Development of Community-based Physical Activity Park for Elderly Population of Pakistan.

Physical inactivity is known to be as performing less than 150 minutes of moderate- to vigorous-intensity physical activity per week. It poses a substantial risk for not only non-communicable, chronic diseases such as stroke, diabetes etc. but also contributes to the global mortality. Evidence suggests that the usual urban green environment is sturdily related to several health paybacks to the elderly population, which includes not only decreased cardiovascular mortality, Type 2 Diabetes risk, but overall improved physical, emotional, and mental health. It also invokes physical activity for community involvement, natural green curative sensory effect, spiritual boost, and leisure recreation to the elderly. Additionally, parks serve to perform activities like exercise, gardening, brisk walk or simply meditation in the natural environment. Unfortunately, in Pakistan, the urban green spaces like parks are scarce. Most people do not have access to well-designed parks. People over the age of 50 and above seem to be most affected by this deficiency. There is a need for specially designed parks that can address the challenges faced by elderly people while exercising. This study summarises the available evidence for designing special open area space in parks for the elderly population across Pakistan and highlights the need for further work to alleviate the global sickness of physical sedentariness among the elderly. Key Words: Older adults, Parks, Physical activity, Physical inactivity.

The effects of inspiratory muscle training on balance and functional mobility: a systematic review.

INTRODUCTION: Inspiratory muscle training (IMT) has been widely used in both healthy and diseased populations especially in older adults, and its effects have been proven not only on inspiratory muscle strength but also on dyspnea, exercise capacity, quality of life, and other health parameters. AIM: This study aims to review the effects of IMT on balance and functional ability of healthy and diseased populations. METHODS: A systematic literature search was conducted on MEDLINE, EMBASE, AMED, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized control trials having participants > 18 years of age and having balance and functional mobility as primary or secondary outcomes were included. Two independent reviewers screened studies against the eligibility criteria, extracted the data, and assessed the quality of evidence. The protocol was prospectively registered on PROSPERO: CRD42021261652. RESULTS: Ten studies were included in the review out of which eight had balance and six had functional mobility as an outcome measure. There was a significant improvement in balance of the participants after treatment with IMT, however the effect on functional mobility was inconclusive. CONCLUSION: The review provided evidence of improvement in balance and functional mobility following inspiratory muscle training in both healthy and diseased adults. Future studies should be conducted to determine the optimal protocol and dosage of treatment.

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.

Effects of Virtual Reality Training Using Xbox Kinect on Balance, Postural Control, and Functional Independence in Subjects with Stroke.

Purpose: To determine the effects of virtual reality training using Xbox Kinect on balance, postural control, and functional independence in subjects with stroke. Methods: The parallel double-blind randomized control trial was conducted on 41 individuals based on selection criteria. Participants were divided into two groups by concealed envelope method. Intervention group received exergaming by Xbox Kinect, and control group was given exercises comprising balance training, upper limb strengthening, and core strengthening. Berg balance scale (BBS), functional independence measure (FIM), trunk impairment scale (TIS), and timed up and go (TUG) were the outcome measures. Data were analyzed using SPSS v21. Results: Mean age of the participants of Xbox and exercise group were 58.6 ± 3.3 and 58.1 ± 4.3 years, respectively. Within group improvement was observed in both groups from baseline to 8 weeks postintervention; BBS: 34 ± 4.7 to 40.9 ± 4.9 in intervention group and 34.1 ± 4.4 to 38.1 ± 7.6 in control group, TUG: 25.6 ± 3.9 to 21.4 ± 3.8 and 28.6 ± 5.0 to 25.9 ± 4.7, TIS: 15.2 ± 1.8 to 19.2 ± 1.3 and 13.2 ± 1.7 to 15.3 ± 1.6 and FIM: 58.7 ± 7.7 to 52.5 ± 7.8 and 66.2 ± 7.6 to 62.6 ± 7.2 in intervention and control group, respectively. Between group improvement was observed in TUG, TIS, and FIM in experimental group with P-values 0.003, <0.001, and <0.001, respectively. Conclusions: Wii Fit improved functional mobility, independence, and trunk coordination extension in the stroke patients, whereas balance could be equally improved from Wii Fit and exercises. Trial Registration Number: ACTRN12619001688178.

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.

Prevalence Of Human Adenovirus In Paediatric Patients Presenting With Acute Respiratory Symptoms At Different Hospitals Of Pakistan.

BACKGROUND: Human Adenovirus (HAdV) is one of the most common causes of infection in children. HAdV commonly affects respiratory system, however can also involve other parts of the body like nervous system, eyes and urinary tract. The virus usually causes a mild infection of the lower and upper respiratory tract. Objective of the study was to find the prevalence of HAdV in paediatric patients presenting with Influenza like symptoms and severe acute respiratory illness across Pakistan. METHODS: This cross-sectional study was conducted at the National Institute of Health, Islamabad. Respiratory swabs were collected from 389 children with age less than five years from 14 hospitals in different regions of Pakistan from October 1, 2017 to September 30, 2018. Patients' demographics, signs and symptoms were recorded through a predesigned proforma while Real-time polymerase chain reaction (RT-PCR) was performed for respiratory samples. RESULTS: Out of all 389 samples, HAdV was found in 25 (6.4%) cases. The proportion of HAdV obtained was greater in females 18 (4.6%) than male 7 (1.8%). The influenza-like illness in children attending outpatient department had a higher prevalence of HAdV 13 (3.3%) compared to admitted children 12 (3.1%). Similarly, patients from one to 6 months of age had higher positive outcome than older children. Majority of positive patients were from Islamabad (2.0%) followed by Gilgit (1.8%), Azad Jammu Kashmir (1.0%), Multan (0.5%), and Karachi (0.5%). The most frequent signs and symptoms were cough, fever, sore throat, nasal congestion and shortness of breath. CONCLUSIONS: The present study concludes that HAdV infection is common in Pakistan especially in female patients aged 1-6 months. It's crucial to improve the diagnosis of HAdV infections in our country to prevent complications associated with the virus. Furthermore, genetic analysis may help find different genotypes of HAdV circulating in Pakistan.

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.