Short-Term Pulmonary Rehabilitation Among Post-Pulmonary Tuberculosis Patients During Coronavirus Disease 2019 Pandemic.

OBJECTIVE: Coronavirus disease 2019 is expected to have a widespread and significant impact on pulmonary tuberculosis services. This study aims to investigate the effect of comprehensive short-term, outpatient pulmonary rehabilitation program among treated pulmonary tuberculosis patients during the coronavirus disease 2019 pandemic. MATERIAL AND METHODS: Forty-five pulmonary tuberculosis patients who completed their tuberculosis treatment were randomly allocated to the outpatient pulmonary rehabilitation group and the other 45 were allocated to the control group for 4 weeks. The pulmonary rehabilitation program comprised supervised endurance and resistance training, breathing techniques, self-management strategies, and patient education. The outcome measures evaluated in both groups were functional capacity assessed by a 6-minute walk test, healthrelated quality of life (short-form 36 questionnaire), pulmonary function (forced expiratory volume in 1 second/forced vital capacity, forced vital capacity, and forced expiratory volume in 1 second), and dyspnea by modified Medical Research Council dyspnea scale. All measurements were performed at enrolment and after completion of 4 weeks protocol in both the groups. RESULTS: There was a significant improvement in 6-minute walk distance in meters (P = .001) and percentage predicted (P = .014) in the pulmonary rehabilitation group compared to the control group. All domains of the short-form 36 questionnaire showed significant improvement post-pulmonary rehabilitation (P < 0.05), and modified Medical Research Council dyspnea scale also significantly improved in the pulmonary rehabilitation group (P < .001). However, no significant differences were observed in any of the pulmonary function measures (P > .05) between the groups after 4 weeks. CONCLUSION: Short-term pulmonary rehabilitation program in pulmonary tuberculosis demonstrated improvement in functional capacity, quality of life, and dyspnea. However, it failed to register changes in pulmonary function. The study results provide motivation to consider the implementation of a short-term pulmonary rehabilitation program after pulmonary tuberculosis treatment to reduce the impairment the patient may suffer even after microbiological cure.

Effect of Chest Physiotherapy on Improving Pulmonary Function in Dealing With Congenital Heart Disease and Lung Collapse: A Case Report.

Patent ductus arteriosus (PDA) is a condition in which the ductus arteriosus fails to close after birth. We present the case of a three-month-old female infant admitted to a tertiary care center with the complaint of cough, poor feeding, and breathing difficulties. Based on the investigatory finding, she was diagnosed with PDA with pulmonary arterial hypertension (PAH), an atrial septal defect (ASD), coarctation of the aorta (COA), and pneumonia. In this patient, a left posterolateral thoracotomy was done to accomplish PDA ligation and coarctation repair. The outcomes of the infants were documented using the face, legs, activity, cry, consolability (FLACC) scale, and arterial blood gas analysis. The therapeutic aim specified an increase in oxygen saturation, enhanced total functional capacity, optimized respiration, cleared chest secretions, and normalized cardiovascular function. The effectiveness of the cardiorespiratory physiotherapy treatment regimen based on the patient's existing state of health is the focus of this case report. The outcome variable indicated that the patient's functional recovery was optimal.

Positive Outcomes of Early Task-Specific Training and Action Observation Mirror Therapy Following Infarction of Hand Knob Area: A Case Report.

Traumatic nerve damage or compression neuropathy is the most common cause of unilateral weakness in an upper extremity. Rarely, a central nervous system lesion may cause syndromes that initially appear to indicate peripheral nerve injury. The most well known of these is pseudoperipheral hand palsy, which is typically brought on by a minor brain lesion in the contralateral motor cortex. The term "hand knob" refers to a restricted area in the posterior frontal lobe's precentral gyrus, a lesion that causes isolated weakness in the upper extremity that mimics injury to peripheral nerves. The majority of the time, an embolic infarction is the cause of this uncommon condition. We present a case of a 52-year-old female who presented to the medicine outpatient department with sudden onset of acute pure motor paresis of the right hand. She also complained of clumsiness in her hand and several episodes of generalized headache in the parieto-occipital region in the past two weeks. Following an initial evaluation by a physician, she was advised for MRI of the head and neck, which reported occlusion in the petrous part of the left internal carotid artery, and referred to physiotherapy for further management. She was assessed and a task-specific training protocol was made for the patient, which also included physiotherapy techniques like grip exercises, mirror therapy, and strengthening. There was an improvement in the patient within a few weeks that was evident with the outcome measures post-rehabilitation. This case study is really a good case not only in regards to peculiarities and clinical presentation but also in promoting rarely implementation of rehabilitation to get patients back to their previous functional status.

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

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

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

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

A Combat Journey With Pulmonary Rehabilitation and Palliative Care in a Patient With Pleural Effusion, Secondary to Metaplastic Breast Carcinoma.

Metaplastic breast cancer is an uncommon and fatal condition. It is described histologically as a tumor having epithelial differentiation into squamous and mesenchymal components, with numerous elements frequently co-existing in the same tumor. This case study sought to provide analgesic treatment in a case with malignant pleural effusion related to breast cancer based on evidence. A 67-year-old female with a known history of metaplastic breast carcinoma came to the tertiary care hospital with complaints of breathlessness which progressed to grade II on the Modified Medical Research Council (mMRC) Dyspnoea Scale, a cough with mucoid expectoration, restlessness, nausea, and reduced appetite for eight days. Diagnostic findings revealed bilateral pleural effusion (left>right). Laboratory investigations revealed that the excess fluid accumulated was transudate in nature, according to the Light's criteria. This case report illustrates the strategy, management, and importance of adherence to pulmonary rehabilitation and painkiller care physiotherapy for patients with metaplastic breast cancer and pleural effusion to achieve the best possible physical and mental health.

Concomitant Pre- and Post-splenectomy Physiotherapy Rehabilitation in a 17-Year-Old Patient With Beta Thalassemia Major: A Case Report.

Thalassemia is a group of disorders having hematological origin. It is hereditary in nature, characterized by a defect in the synthesis of alpha or beta chains of hemoglobin leading to alpha or beta thalassemia, respectively. Based on the severity, beta thalassemia can be minor, intermittent, or major. Patients with thalassemia major require frequent blood transfusions, which come with various complications, of which hepatosplenomegaly is the most common. A 17-year-old male patient had a chief complaint of stomach ache and fever for the last five days. He was on a monthly blood transfusion. USG impression revealed hepatosplenomegaly and cholelithiasis. Splenectomy along with cholecystectomy was done as a part of surgical management after which a comprehensive pre- and postoperative physiotherapeutic rehabilitation program has been inculcated incorporating various respiratory techniques, strength training, and home exercise program, hence helping the patient to return to his routine daily activities efficiently. The Numeric Pain Rating Scale, Fatigue Severity Scale, and Beck Anxiety Inventory were used as outcome measures over four weeks to demonstrate the efficacy of the treatment. In this case study, a well-planned comprehensive physiotherapy rehabilitation protocol has proven helpful in improving quality of life, maximizing functional capacity, and reducing anxiety and depression in the patient.

Psychological Consequences Associated With Coronary Artery Bypass Graft Surgery: A Bibliometric Analysis.

The current paper explores the mutual impact of psychological factors and cardiac surgery on each other using bibliometric analysis with the help of indicative cited publications, co-cited journals, and collaborations between countries, institutions, and authors. Citation analysis is an attractive methodology because it provides quantitative information that is readily acquired with electronic databases and that can be compared across topic areas. The bibliometric investigation was done using the PubMed database, Scopus, Web of Science, etc. with the help of appropriate MeSH words. Followed by an analysis of data with the help of CiteSpace 5.3.R4, Microsoft Excel 2016, and IBM SPSS Statistics 20.0 software (IBM Corp., Armonk, NY). The software extracts the number of scientific publications, citation frequency, and keyword trends. Relational figures and tables were obtained for data interpretation. The records of 259 articles were analyzed using bibliometric investigation which shows the increasing incidence of psychological consequences linked with coronary artery bypass grafting (CABG) surgery. This indicates that immediate management is required to overcome this. The present bibliometric study emphasizes the need for psychological screening and management of post-CABG patients. This will lay the path for organizing and prioritizing future research on vascular psychiatry and its early management.

Palliative Care as an Adjunct to Standard Pulmonary Rehabilitation: A Pathway To Improving Functional Independence & Quality of Life in a Patient With Lung Cancer.

Adenocarcinoma of the lung along with malignant pleural effusion is an autonomous predictor of decreased survival, thus the main focus of the clinician should be on palliative care. In this case report, we describe chemotherapy, palliative care physiotherapy, and the necessary pulmonary rehabilitation approaches that were used for our patient. It offers a path to treatment planning, with a day-wise protocol aimed at alleviating the patient's symptoms. The patient came to the respiratory medicine department with complaints of severe cough with mucoid expectoration, breathlessness, and generalized weakness; on examination, the patient was tachypneic, tachycardic, and had grade 1 clubbing. His CT scan and chest radiography revealed wide opacity covering most of the right lung, suggesting pleural effusion. When the pleural fluid was examined, it was hemorrhagic and malignant. Thus, he was diagnosed with adenocarcinoma of the lung. A few days later, the patient was referred to a respiratory physiotherapist, who assessed him and recommended a palliative care program and pulmonary rehabilitation. On the day of assessment, the patient was evaluated using various outcome measures, the same measures were again evaluated on the day of discharge and follow-up. These outcome measures revealed significant improvements in cough severity, breathlessness, depression, anxiety, pulmonary capacities, incision site pain, weakness, and overall quality of life. Hence, it is reasonable to conclude that a well-planned pulmonary rehabilitation and palliative care program will improve the patient's respiratory, musculoskeletal, and psychological manifestations during his remaining days.

Emphasizing Pulmonary Function With Respiratory Therapy in an Infant With Congenital Adrenal Hyperplasia, Bronchopneumonia and Leptomeningitis.

A set of hereditary diseases affecting the adrenal glands, a couple of walnut-sized structures above the kidneys, is known as congenital adrenal hyperplasia (CAH). The adrenal glands generate essential hormones like cortisol, mineralocorticoids, and androgens. It is usually diagnosed in the early neonatal period. The documentation of this case study is aimed to provide a case of an infant with CAH associated with bronchopneumonia and leptomeningitis. Brought with complaints of poor feeding, moderate fever associated with chills, and loose stools, was an 11-months-old patient with a known diagnosis of CAH. Symptoms have shown that the baby was in a possible adrenal crisis. He was intubated with an endotracheal tube after repeated episodes of seizures. Investigations revealed signs of bronchopneumonia and leptomeningitis. A thorough assessment, once completed, helped in analyzing relevant problems to be treated with respiratory therapy. Respiratory therapy, in this case, was aimed at improving the blood oxygen levels and assisting breathing by clearing out secretions and opening up the airways. Parent education was the foremost part of the treatment regime, followed by bronchodilator administration, conventional chest physiotherapy, postural drainage positions in the mother's lap, lung squeezing technique, and perioral pressure. A holistic and multidisciplinary approach is beneficial in patients with CAH undergoing an adrenal crisis. It needs to be offered to the patients who would be benefited, considering the effect, which needs to be reassessed on specific outcomes with changes in the management with the improving condition.

Early Rehabilitation for Cerebellar Complications Following Left Atrial Myxoma Excision: A Stitch in Time Saves Nine.

The most known of all primary cardiac tumors is myxoma, which is most usually detected in the left atrium. As there are no physical signs or symptoms, a diagnosis is rarely made purely based on clinical evidence. Our study aims to investigate the case of post-operative left atrial myxoma with cerebellar signs. A 50-year-old woman complained of dizziness and syncope, which caused her to collapse on the floor early in the morning. Myxoma in the left atrium and mitral valve regurgitation was discovered after prompt medical assistance. She was recommended for surgery to excise the left atrial myxoma and mitral valve repair. Post the surgery, she developed breathing difficulties and cerebellar signs for which she was referred for physiotherapy. She underwent two weeks of tailor-made inpatient rehabilitation. This case study intends to emphasize the importance of early diagnosis, treatment, and, most importantly, rehabilitation to return the patient to her functional state. A structured exercise regimen assists the patient while also reducing post-surgery problems. Timely monitoring and treatment are projected to improve outcomes in patients treated with a multidisciplinary approach.

Corroborating Psychological Rehabilitation With Cardiac Rehabilitation to Optimize Recovery in Post Coronary Artery Bypass Graft Patient: A Case Report.

Besides various advancements in technologies, cardiac surgeries are associated with various pulmonary and psychological consequences. In this article, we describe the case of an elderly female patient who presented to the emergency unit with complaints of severe chest pain, breathlessness, and sweating. She was diagnosed with triple vessel disease and underwent coronary artery bypass graft (CABG) surgery. Post-operatively she was anxious, restless, and complained of pain and difficulty in breathing. For which a comprehensive tailor-made rehabilitation program was designed by the Cardio-Pulmonary Physiotherapist, which included cardiac rehabilitation along with psychological rehabilitation, which proved to be effective in substantial gains in both physical and mental wellbeing. This provides a pathway towards the treatment planning and aspects of patient problems that should be focused on, along with an effective day-wise protocol to improve patients' symptoms using both physical and mental perspectives. The patient was assessed using various outcome measures, which revealed drastic changes in breathlessness, depression, anxiety, pulmonary capacities, and overall quality of life. We conclude that anchoring psychological rehabilitation to cardiac rehabilitation will provide effective management and improve the overall quality of life of such patients and healthcare burden.

Impact of Early Physiotherapy Rehabilitation for Pleural Empyema in a Geriatric Patient.

Empyema is the accumulation of pus in the pleural cavity which can be linked to lung abscesses, trauma, septicemia, or spinal osteomyelitis. It is usually caused by a lung infection that extends to the pleural space and causes pus to accumulate. Here, we present the case of a 70-year-old male who complained of dry cough for 15 days, breathlessness on walking for 20 days, right-sided chest and upper back pain, and high-grade fever for 15 days. On investigation, pleural empyema was diagnosed. He underwent a thoracoscopy to drain the fluid and an intercostal drainage tube was inserted. Along with medical management, physiotherapy was also required to help the patient to perform his daily activities with ease. A physiotherapy protocol was developed for the patient to improve his condition.

Rehabilitation towards functional independence in patient with abdominal tuberculosis undergone abdominal surgery: a case report.

A small bowel obstruction is one of the most prevalent life-threatening situations. The most common clinical signs are vomiting, stomach discomfort, abdominal distension, and severe constipation. A 23-year-old girl presented to the multispecialty hospital with stomach pains that had persisted for two days. The patient experienced identical issues two months earlier and was treated conservatively. Radiography in the manner of abdominal X-ray and ultrasound were used to appropriately diagnose intestinal blockage. She underwent exploratory laparotomy for the same. Numerical pain rating scale, Incentive Spirometer (IS), mobility scale, anxiety and depression scale, independence measure were used as an outcome measure. Medical management was successful, but to return the patient to her normal daily routine activities without signs of dyspnea or early fatigue following abdominal surgery, a comprehensive rehabilitation program incorporating various respiratory techniques was developed, which proved to be effective and correlated with medically substantial gains in physical functioning and wellbeing.

Effect of Dance Movement Therapy on Cancer-Related Fatigue in Breast Cancer Patients Undergoing Radiation Therapy: A Pre-post Intervention Study.

Introduction Dance movement therapy (DMT) is a movement-based psychosocial intervention that incorporates the therapeutic components of dance movements and group psychotherapy. DMT, also known as creative movement therapy (CMT) is a psychotherapy used as a complementary therapy in cancer care. It helps in enhancing mood, emotions, self-expression and helps to rebuild self-confidence. Besides, it allows the patients to recognise their own strengths and weaknesses as well as helps to improve physical capabilities. Methods By simple random sampling method, 30 breast cancer patients were recruited at Pravara Rural Hospital, Loni, Maharashtra, India. The participants were in the age range of 30-60 years based on the inclusion and exclusion criteria. Pre-intervention scores of cancer-related fatigue (CRF) were taken using the Brief Fatigue Inventory (BFI) scale and intervention was given for 45 minutes each day for 5 days a week, over a span of 2 weeks. Thereafter, post-intervention assessment was done and the scores were noted. Pre-intervention and post-intervention scores were compared using paired t-test. Results The mean and standard deviation (SD) of pre- and post-BFI scores derived by using paired t-test was 73.76 (8.6) and 69.33 (9.8), respectively, with a p-value of < 0.001, which is highly significant. Conclusion The results of the present study revealed that DMT seems to be effective in reducing some amount of CRF in breast cancer patients undergoing radiation therapy. Besides, it turned out to be an engaging, entertaining and cost-effective approach. The investigation showed that DMT appears to be beneficial in reducing the side effects of radiation therapy such as pain, stress, anxiety and fear, giving a psychotherapeutic relief but did not completely remove the persistent fatigue experienced by the breast cancer patients. Thus, further investigation with long-term follow-up is recommended.