An eight-week single-blind randomised controlled trial on dual task balance training and motor imagery practice in ischaemic stroke survivors.

The purpose of this study was to find the effects of motor imagery on balance and mobility of stroke patients.This was a single-blind randomised controlled trial which included a total of 30 patients. These patients were assigned into two group: experimental (n=15) and control (n=15) by sealed envelope method. Functional Reach Test (FRT), Time Up and Go Test (TUGT), Berg Balance Scale (BBS), and Movement Imagery Questionnaire (MIQ) were used as assessment tools. The overall mean age of the participants was 52.63 ±8.78 years. Between groups analysis showed non-statistically significant difference (p>0.05) in FRT but significant difference in TUGT, BBS, and MIQ-3 (p<0.009) after eight weeks of training. Within group analysis showed statistically significant difference (p<0.05) for all outcome measures. This study concluded that motor imagery is an effective treatment strategy for improving balance and mobility in stroke patients and brings better results as compared to conventional treatments.

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 vestibular rehabilitation therapy versus virtual reality on balance, dizziness, and gait in patients with subacute stroke: A randomized controlled trial.

BACKGROUND: Stroke is a neurological disorder with a vascular cause, such as cerebral infarction or hemorrhage, and causes dizziness, balance, and gait impairments in patients. Vestibular rehabilitation therapy (VRT) involves a variety of exercises that can improve balance, gait, and gaze stability in stroke patients by affecting the vestibular system and improving dynamic balance. By providing a virtual environment, the use of virtual reality (VR) can aid stroke patients in improving their balance and gait. OBJECTIVE: This study aimed to evaluate the comparative effects of vestibular rehabilitation with virtual reality on dizziness, balance, and gait in patients with subacute stroke. METHODS: The randomized clinical trial involved 34 subacute stroke patients randomly assigned to 2 groups; 1 received VRT and the other VR treatment. To assess mobility and balance, the Time Up and Go test was used, the Dynamic Gait Index was used to assess the gait, and the Dizziness Handicap Inventory was used to determine the level of dizziness symptoms. Each group received 24 sessions of allocated treatment, 3 sessions every week for 8 weeks. Using SPSS 20, both groups pretest and posttest readings were analyzed and compared. RESULTS: Between the VR and VRT groups, balance (P-.01) and gait (P-.01) were significantly improved in the VR group, while dizziness was significantly improved in the VRT group with P < .001. On within-group comparison, both groups showed significant improvements in balance, gait, and dizziness with P < .001. CONCLUSION: Both vestibular rehabilitation therapy and VR improved dizziness, balance, and gait in subacute stroke patients. However, VR was more effective in improving balance and gait among patients with subacute strokes.

Effects of Half-Somersault and Brandt-Daroff exercise on dizziness, fear of fall and quality of life in patients with posterior canal benign paroxysmal positional vertigo: A randomised control trial.

The aim of this study was to compare the effects of Half-Somersault and Brandt-Daroff exercises on dizziness, fear of fall, and quality of life in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV). This study was conducted from July 2020 to November 2020. A total of 20 patients were enrolled in the study, through sealed envelope method, and assigned to two groups, A and B (10 in each). Vestibular activity and participation measure and Fall Efficacy Scale (FES) were used. The mean age of the patients was 36.70±11.58 years. There was a significant (p=0.05) difference between the Vestibular activities and participation measure (VAP) score at post intervention and Fall Efficacy Scale (FES) (p<0.05) between the groups. Within group analysis showed significant results (p=0.01). This study concluded that both manoeuvers are significantly effective in the treatment of PC-BPPV, but patients treated with Brandt-Daroff exercises reported more improvement in terms of quality of life and residual dizziness compared to the Half Somersault group. Clinical Trials.gov identifier (NCT number): NCT04469309.

Comparison of classic constraint-induced movement therapy and its modified form on upper extremity motor functions and psychosocial impact in hemiplegic cerebral palsy.

A prospective randomised control trial (RCT) was conducted in National Institute of Rehabilitation Medicine (NIRM), Islamabad, on 40 children with hemiplegic cerebral palsy (HCP). Children between the ages of four and12 years with ipsilateral, bilateral or severely asymmetrical impairments who had wrist extension (20°) and fingers flexion (10°) were included. The outcomes tools, Box and Block Test, Quality of Upper Extremity Skill Test, CP (Quality of Life) and Kid screen were used at baseline, mid- and post- treatment assessment. Both the treatment approaches (CCIMT AND MCIMT) equally improved upper limb motor functions and psychosocial life of the children with HCP. On Quest tool, results of dissociated movement were significant (p=0.021) and on CPQOL tool two domains (participation & physical health and family health) showed significant difference (p=0.042, p=0.025). But no significant difference was noted regarding other domains of the tools. The study concluded that both the treatment approaches (CCIMT AND MCIMT) are effective in enhancing the upper limb motor functions and psychosocial life of children with HCP.

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.

Comparison of exergaming and vestibular training on gaze stability, balance, and gait performance of older adults: A single blind randomized control trial.

Objectives: To compare the effects of exergaming and vestibular training on gaze stability, balance and gait performance of older adults. METHODS: The single-blind randomised controlled trial was conducted from August to October 2020 at the Doctor Raza Clinic, Swabi, Pakistan, and comprised individuals of both genders aged 60-75 years. The subjects were randomised into two groups using the sealed envelope method. Group 1 received exergaming, while group 2 received vestibular training 3 days a week for 6 weeks. The outcomes measures were dynamic gait index, time up and go test and non-instrumented dynamic visual acuity test. Data was analysed using SPSS 21. RESULTS: Of the 24 subjects, 12(50%) were in each of the two groups. Overall, there were 16(66%) males and 8(33%) females with a mean age of 66.3±4.36 years. Intra-group improvement was significant compared to the baseline (p<0.05) in both the differences, but inter-group differences across all parameters were non-significant (p>0.05). CONCLUSIONS: Both exergaming and vestibular training has similar effects on gaze stability, balance, and gait performance among the older adults. Clinical Trials.gov Identifier: NCT04414462.

The effects of an exercise programme for core muscle strengthening in patients with low back pain after Caesarian-section: A single blind randomized controlled trial.

OBJECTIVE: To determine the effects of an exercise programme for core muscle strengthening in patients with low back pain after caesarean section. METHODS: The single-blind randomised controlled trail was conducted from August 2018 to January 2019 at the Helping Hand for Relief and Development Comprehensive Rehabilitation Centre, Chakwal, Pakistan, and comprised post-caesarean section women aged 25-40 years with low back pain. Patients were randomised into supervised group I and unsupervised group II using the sealed envelope method. Group I received supervised core stability exercise programme, while group II received unsupervised, home-based core stability exercise programme. Baseline and post-intervention values were compared for numeric pain rating scale, Oswestry disability index, inclinometer and core stability assessment. Data was analysed using SPSS 21. RESULTS: Of the 30 subjects, there were 15(50%) in each of the two groups. There was no significant difference at baseline between the groups (p>0.05). Post-intervention results showed significant intra-group and inter-group differences (p<0.05) with respect to all parameters. No improvement was observed for right and left side bending (p>0.05). CONCLUSIONS: Supervised core stability exercise programme was more effective in reducing pain and disability, and improved core muscle activation than unsupervised, home-based core exercise programme.

The effects of a static exercise programme versus Swiss ball training for core muscles of the lower back and pelvic region in patients with low back pain after child delivery. A single blind randomized control trial.

OBJECTIVE: To determine the effects of static exercise programme compared to Swiss ball training for core muscles of the lower back and pelvic region in patients with low back pain after child delivery. METHODS: The prospective single-blind randomised controlled trial was conducted at Rehabilitation department of Pakistan Railway General Hospital Rawalpindi from March to December 2018, and comprised patients with low back pain after delivery who were randomised into 2 equal groups. The subjects in Group A received static core exercises, while those in Group B got Swiss ball training. Outcome was measured using numeric pain rating scale, Oswestry disability index, goniometry and core stability assessment scale. Data was analysed using SPSS 21. RESULTS: Of the 30 patients, 15(50%) were in Group A with mean age of 28.38±4.8 years, and 15(50%) were in Group B with a mean age of 29.57±3.3 years. Intra-group difference was significant (p<0.05), while inter-group difference was non-significant (p>0.05). CONCLUSIONS: Both exercise protocols used in the study were equally effective in the rehabilitation of postpartum low back pain.

Effects of core muscle stability on low back pain and quality of life in post- menopausal women: A comparative study.

OBJECTIVE: To determine the effects of core stability exercises on backache and quality of life of postmenopausal women. METHODS: he comparative study was conducted at the Department of Physical Therapy, Margalla General Hospital, Rawalpindi, Pakistan, from February to June 2018, and comprised post-menopausal woman aged 40-60 years having backache who were randomly divided into experimental group A and control group B. Group A underwent core stability exercises along with traditional therapy, while group B had traditional low backache physical therapy. Each participant was treated three days a week for 12 weeks. The outcome was assessed using the manual muscle testing numerical pain rating scale, Oswestry disability index and Utian quality of life scale at baseline, week 6 and week 12. Data was analysed using SPSS 21. RESULTS: Of the 35 subjects initially enrolled, 24(68.5%) completed the study. Of them, 14(58.3%) cases were in group A and 10(41.6%) controls in group B. The overall mean age was 54.54±5.13 years, mean menopause duration was 99.79±50.02 months, and mean duration of backache complaint was 23.95±14.85 months. Differences in outcome were significant between the groups for flexion and extension manual muscle testing and Utian quality of life scale (p<0.05) and non-significant for numerical pain rating scaleand Oswestry disability index (p>0.05). CONCLUSIONS: Core stability exercises were found to have the ability to reduce pain, disability and to improve strength and quality of life.

Comparison between dynamic oscillatory stretch technique and static stretching in reduced hamstring flexibility in healthy population: A single blind randomized control trial.

OBJECTIVE: To compare the effects of dynamic oscillatory stretch and static stretching techniques in order to improve hamstring extensibility in healthy individuals with asymptomatic hamstring tightness. METHODS: The single-blind randomised controlled trial was conducted from March to June 2018 at Sadiq Hospital, Sargodha Institute of Health Sciences, and District Headquarter Teaching Hospital,Sargodha, Pakistan, and comprised young healthy individuals with hamstring tightness who were randomly divided into groups 1 and 2, with the former getting exposure to oscillatory stretch technique and the latter to static stretching technique. Assessment of hamstring length was done using reliable clinical measurement test along with pain for stretch tolerance during passive straight leg raise using numeric pain rating scale. Measurements were taken at baseline, immediate (10min) and 1 hourpost-intervention. Data was analysed using SPSS 20. RESULTS: Of the 83 subjects, 42(%) were in group 1 with a mean age of 24.22±4.09 years, and 41(%) were in group 2 with a mean age of 25.85±6.09 years.Group1 showed significantly more improvement in all variables of hamstring flexibility and perceived pain at both post-intervention checkups compared to group 2 (p<0.05). CONCLUSION: Dynamic oscillatory stretch technique was found to be more effective in improving hamstring flexibility and perceived pain compared to static stretching technique.

Effects of post-isometric relaxation, myofascial trigger point release and routine physical therapy in management of acute mechanical neck pain: a randomized controlled trial.

OBJECTIVES: To compare the effects of post-isometric relaxation, myofascial trigger point release and routine physical therapy on pain, disability and cervical range of motion in patients with acute mechanical neck pain. METHODS: The randomised control trial was conducted at the District Headquarter Hospital in Nowshehra, Pakistan, from July to December 2017 and comprised subjects of either gender aged 16-49 years with acute neck pain. They were randomised into three groups; post-isometric relaxation group 1, myofascial trigger point release group 2 and routine physical therapy group 3. Neck disability index, numeric pain rating scale and cervical goniometry were documented before intervention, after the first session and after 6 sessions in two weeks. Data was analysed using SPSS 21. RESULTS: Of the 60 patients, there were 20(33.3%) in each of the three groups. Mean age in group 1 was 32.25±9.56 years, group 2 2.35±9.05 years and in group 3 it was 32.75±7.82 years. Scores for neck disability index and numeric pain rating scale as well as rotation to right and left showed significant difference among the groups post-treatment (p<0.05). Within group analysis showed significant improvements in all parameters post-treatment in all the groups (p<0.0001). CONCLUSIONS: Acute mechanical neck pain treated with post-isometric relaxation technique had more and faster effect in decreasing pain and disability and in improving mobility.

Factors associated with sleep deprivation and their impact on academic performance of hostelites of twin cities of Pakistan.

OBJECTIVE: To determine the factors associated with sleep deprivation and their impact on academic performance of students living in a hostel setting. METHODS: It was a correlational study conducted from January to June, 2018 in Rawalpindi and Islamabad, Pakistan, and comprised university students of either sex aged 18-25 years who were studying at different universities of the twin cities. A semi-structured questionnaire was used along with Pittsburgh Sleep Quality Index to collect data which was analysed using SPSS 21. RESULTS: Of the 850 students, 450(50%) each were males and females. The overall mean age was 21.10±1.84 years. There was academic stress in 672(79%) students which disturbed the normal sleep cycle. Other factors affecting students; sleep were financial issues 632(74%), uncomfortable bed mattresses 671(79%), environmental noise 468 (53%), poor ventilation 666 (78%), hostel near commercial places 233(27%), and the habit of playing mobile games 545(65%). Female students had more sleep problems than males (p<0.05). Bivariate correlation showed no association of these factors and cumulative grade point average (p>0.05). CONCLUSION: The most common factors found to be influencing hostelites' sleep were stress, financial issues, uncomfortable mattresses, environmental noise and playing games on mobile before sleep. Disturbed sleep did not affect academic performance.

Level of satisfaction regarding physical therapy services in district Poonch, Azad Jammu Kashmir.

OBJECTIVE: To determine the patients' satisfaction level regarding physical therapy services at districtlevel hospitals. METHODS: The cross-sectional study was conducted at tertiary hospitals of Poonch district in Azad Jammu and Kashmir from January to June 2018, and comprised patients of either gender aged 15-70 years receiving physical therapy treatment. A semi-structured questionnaire was used to collect data regarding patients' satisfaction from physiotherapy services.. The demographics were recorded and standardized assessment tools used included Short-Form Patient Satisfaction Questionnaire and Medrisk instrument for measuring patient satisfaction. Data was analysed using SPSS 22. RESULTS: Of the 392 subjects, 209(53%) were males and 183(47%) were females, with an overall mean age of 39.7±12.6 years. The response regarding satisfaction was positive in 376(95.85%) cases and negative in 16(4.15%) cases (p<0.05). CONCLUSION: There was a high level of satisfaction regarding physiotherapy services in the studied area.

Comparison of Spencer muscle energy technique and Passive stretching in adhesive capsulitis: A single blind randomized control trial.

OBJECTIVE: To compare the effects of Spencer muscle energy technique and passive stretching in adhesive capsulitis. METHODS: The single-blind randomised control trial was conducted at the District Headquarter Hospital and Fatima Hospital, Sargodha, Pakistan, from February to May 2018, and comprised patients of either gender aged 30-55 years with idiopathic frozen shoulder stage 1 and 2 or stiff painful shoulder joint for at least 3 months. They were randomised into two equal groups using the sealed envelope method. Group 1 was exposed to muscle energy technique, while group 2 was exposed to passive stretching. Pain, shoulder range of motion and function were assessed by numeric pain rating scale, goniometer, shoulder pain and disability index and the quick version of the disabilities of the arm, shoulder and hand questionnaire. Measurements were taken at baseline, 2nd and 4th week. Data was analysed using SPSS 20. RESULTS: Of the 60 patients, there were 30(50%) in each of the two groups. There were 39(65%) females and 21(35%) males with an overall mean age of 45.84±5.88 years. All parameters significantly improved in group 1 compared to group 2 t post-intervention (p<0.001). CONCLUSIONS: Spencer technique was found to be more effective than passive stretching in treating patients with adhesive capsulitis.

Comparison between Manual Traction, Manual Opening technique and Combination in Patients with cervical radiculopathy: Randomized Control Trial.

OBJECTIVE: To compare the effects of manual traction, manual intervertebral foramen opening technique and combination of the two techniques in patients with cervical radiculopathy. METHODS: The single-blind randomised control trial was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 2017 to January 2018, and comprised patients of either gender having unilateral upper extremity pain, paresthesia or numbness. The subjects were placed into groups I, II and III using sealed envelope method. Group I was treated with the opening of intervertebral foramen technique, while group II received manual traction of cervical spine, and group III received both techniques. Three sessions were conducted per week for 3 weeks. The outcome measures were neck disability index, Numeric pain rating scale, patient-specific functional scale, and range of motions of cervical spine. SPSS 21 was used for data analysis. RESULTS: Of the 40 patients, 17(30%) were males and 23(70%) were females. There were 13(32.5%)patients each in groups I and II, while group III had 14(35%). Mean age in group I was 42.41±6.86 years, in group II 40.95±7 .32 years and in group III 42.50±5.77 years. There was no statisticallysignificant difference among the three groups with respect to any parameter (p>0.05). Individual group analysis showed significant improvement (p<0.05) in all parameters . CONCLUSIONS: Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy.

The Association Between Physical activity with Cognitive And Cardiovascular Deconditioning In Age Related Decline Of College Students.

OBJECTIVE: To determine the association between physical activity and cognition in age-related decline of college students and to find the correlation between physical activity with cardiovascular deconditioning. METHODS: The analytical cross-sectional study was conducted from January 1 to May 1, 2017, in different medical and engineering colleges of Rawalpindi and Islamabad in Pakistan.Data was collected through non-probability purposive sampling method. Demographic data was recorded and standardized assessment tools, including physical activity index and stroop colour word test for cognition, were used. Bivariate correlation analysis was used to determine association between different variables. RESULTS: Of the 702 subjects, 340(48.5%) were males and 362(51.7%) were females. The overall mean age was 21.84±1.73 years (range: 17-24 years), and mean body mass index was 22.12±3.6.Overall, 292 (41.8%) students were labelled as physically active and 410(58.8%) had sedentary lifestyle.Physical activity and cognition showed positive association (p=0.004) in students.Physically inactive participants showed cardiovascular and cognitive deconditioning with age (p = 0.68). CONCLUSIONS: Physical activity was found to be a key tool of cardiovascular health and cognition.It ameliorated overall health and brought better academic performance of students engaged in sports-related activities.

Effects of activity repetition training with Salat (prayer) versus task oriented training on functional outcomes of stroke.

Stroke is one of most disabling condition which directly affects quality of life. The objective of this study was to compare the effect of activity repetition training with salat (prayer) versus task oriented training on functional outcomes of stroke. The study design was randomized control trial and 32 patients were randomly assigned into two groups'. The stroke including infarction or haemorrhagic, age bracket 30-70 years was included. The demographics were recorded and standardized assessment tool included Berg Balance Scale (BBS), Motor assessment scale (MAS) and Time Up and Go Test (TUG). The measurements were obtained at baseline, after four and six weeks. The mean age of the patients was 54.44±10.59 years with 16 (59%) male and 11(41%) female patients. Activity Repetition Training group showed significant improvement (p<0.05) and is effective in enhancing the functional status as compare to task oriented training group. The repetition with motivation and concentration is the key in re-learning process of neural plasticity.