Determining the Optimal Position of Surface Electrodes for Diaphragm Electromyography: A Cross-Sectional Study.

BACKGROUND: Placing electrodes on different aspects of the chest determines the motor firing from the diaphragm. The electrode placement close to the extent of the muscle gave promising readings as compared to the ones that were placed away. The position with the maximum amplitude and least duration was chosen. Positions of the electrodes were decided as per the extent of the muscle. The aim is to determine the appropriate position of surface electrodes for surface diaphragm electromyography (EMG). MATERIAL AND METHODOLOGY: Thirty healthy individuals of age ranging from 21 to 45 years were included in the study. Participants were made to lie down in a supine position and different positions like G1 (recording electrode) 5 cm superior to the tip of the xiphoid process and G2 (reference) 16 cm along the costal margin from G1, G1 over the xiphoid tip and G2 at the seventh intercostal space at the costochondral junction and G1 over the xiphoid tip and G2 at the eight intercostal space at the costochondral junction were used for assessing maximum amplitudes and durations were observed by using a Octopus New Wave EMG machine (Octopus Medical Technologies, Vadodara, IND). After observing all the positions, an optimum position for maximum amplitude and least duration was analyzed. RESULTS: As per the study, out of the four positions, the electrode placements on the tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space showed maximum amplitude and the least duration with maximum mean amplitude and less mean duration of 232.35 and 7.316. On the seventh intercostal space it was 199.15 and 7.887 and on the eighth intercostal space was 176.055 and 8.639. The tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space is chosen as the appropriate position for electrode placement for EMG of the diaphragm. CONCLUSION: We conclude that the best electrode position was when the electrodes were placed 5 cm superior to the xiphoid process, i.e., G1, and 16 cm away from the recording electrode on the costochondral junction, i.e., G2, at the sixth intercostal space. Ground electrode placement is the nearest bony prominence, i.e., xiphisternum.

Effect of oculomotor exercises in patients with non-specific chronic neck pain and associated visual complaints.

Background: Neck pain is a common musculoskeletal disorder, the most common type being non-specific chronic neck pain. It usually involves postural or mechanical causes. In Individuals with neck pain, a notable prevalence of visual complaints has been predominantly reported. It can be linked to the mismatch in the cervical afferent output. Objective: This study aimed to assess the effect of oculomotor exercises on neck pain, neck disability, gaze stability and visual complaints among individuals with non-specific chronic neck pain and associated visual complaints. Methods: A total of 32 individuals with non-specific chronic neck pain and associated visual complaints were equally randomised into two groups. To receive either: stretching to the sternocleidomastoid and anterior scalene along with neck Isometric exercises (Group A, conventional) or the conventional protocol along with oculomotor exercises (Group B, experimental). The protocol was given for three alternate days a week for three weeks, a total of nine sessions. The outcome measures were the Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI) for disability, Dynamic Visual Acuity (DVA) test for gaze stability and Visual Complaints Index (VCI) for visual complaints. Results: Significant results were seen for the DVA (p=0.002) and VCI (p=0.024), suggesting improvements in gaze stability and visual complaints using oculomotor exercises. Conclusion: From this study, we highlighted that oculomotor exercises along with conventional treatment led to improvement in visual complaints and gaze stability in patients with non-specific chronic neck pain and associated visual complaints.

Effects of Movement Retraining and Lumbar Stabilization Exercises in Mechanical Low Back Pain: A Pilot Study.

Objective To determine and compare the effects of movement retraining (MR), lumbar stabilization exercises (LSE), and a combination of both these exercises on pain, flexibility, strength, and functional disability in chronic mechanical low back pain (CMLBP) patients. Materials and methods Fifteen CMLBP participants, aged 20-40 years, were randomly allocated into three groups. Group A (n=5) received MR, group B (n=5), LSE, and group C (n=5), a combination of MR and CSE, along with hot packs for eight weeks, thrice a week on alternate days. Outcomes used were the Numerical Pain Rating Scale (NPRS), Modified Modified Schober's Test (MMST), Pressure Biofeedback (PBU), Roland Morris Disability Questionnaire (RMDQ), and Movement Control (MC) dissociation tests to identify MC impairments and were assessed at pre-intervention, post-four weeks, and post-eight weeks. The data were analyzed using repeated measures ANOVA. The level of significance was considered at p-value<0.05. Results Participants with CMLBP significantly improved in all variables in all three groups (p-value≤0.05). On inter-group comparison, group A showed better improvement in lumbar extension range of motion than the other two groups, with a mean difference of MMST in group A of 0.62±0.30, group B of 0.52±0.22, and group C of 0.36±0.02, with a p-value ≤0.002. Group C showed more improvement in core strength, with a mean difference of 5.0±0.25 in group A, 3.2±0.56 in group B, and 5.2±0.57 in group C, with a p-value ≤0.03. A significant improvement was observed in NPRS, MMST flexion, RMDQ, and uncontrolled movements (UCMs). Conclusion All three methods of treatment are effective in the management of CMLBP. Clinically, kinetic control showed better improvement in reducing pain and improving lumbar flexion and extension range of motion. Functional disability was better improved with lumbar stabilization exercises, and core strength was improved with a combination of KC and LSE. However, a combination of MR and LSE helps improve core strength, and movement retraining improves lumbar extension.

Effectiveness of instrument assisted soft tissue mobilization versus foam rolling on trigger point release in calf muscles.

BACKGROUND: Instrument assisted soft tissue mobilization and foam rolling are two techniques that have been proven effective in treating Myofascial Trigger Points, irrespective of the type of trigger point. However, little is known about the comparative effectiveness of Instrument assisted soft tissue mobilization and foam rolling. This study proposed to evaluate the effectiveness of either technique on plantar flexors trigger points, ankle dorsiflexion, and lower limb power present in the calf muscles in non-symptomatic patients. METHOD: Forty-two subjects with bilateral calf muscle tightness, at least one trigger point in the calf muscle, and fulfilling the inclusion criteria were randomly assigned to either of the groups. Group A was treated for gastrocnemius and soleus trigger points using Instrument assisted soft tissue mobilization and Group B was treated using the Foam Rolling method. Treatment was given every alternate day, a total of 3 sessions. Subjects were evaluated on 1st and 3rd sessions for pre-post differences of ankle dorsiflexion Range of motion in weight bearing and non-weight bearing position, pressure pain threshold for gastrocnemius trigger point 1(G1), 2(G2), and soleus point 1(S1) on both sides, and lower limb power. RESULT: Within group analyses, both groups had shown statistically significant results for all parameters except gastrocnemius trigger point 2 of foam rolling. For between group comparison foam rolling had a statistically significant result in non-weight bearing ankle dorsiflexion range of motion. CONCLUSION: Both Instrument assisted soft tissue mobilization and Foam rolling were equally effective for treating calf trigger points. But foam rolling was more effective in improving ankle dorsiflexion range of motion.

Revitalizing Recovery: Unveiling the Transformative Impact of Physiotherapy in Rehabilitating a Neglected Case of Shoulder Hemiarthroplasty.

The shoulder joint has a complex anatomy and biomechanics. It is a ball and socket joint made by the articulation surface of the humeral head (ball) and glenoidal fossa (socket) of the scapula. Shoulder arthroplasty is done when parts of the shoulder joint are severely affected and damaged beyond repair. The damaged parts are replaced with artificial parts. Prosthetic implants are typically made of metal or plastic material. Implants come in various sizes and shapes. There are three types of surgical arthroplasty: total shoulder arthroplasty, partial shoulder arthroplasty, and reverse arthroplasty. Indications of shoulder arthroplasty may include osteoarthritis, fractures, rotator cuff injuries, osteonecrosis, and rheumatoid arthritis. This case study aims to provide a case of anteroinferior dislocation of the left shoulder with humeral head comminuted fracture confirmed by an investigation like radiograph and CT scan operatively managed by left shoulder hemiarthroplasty. In this case study, a 58-year-old male cannot lift his arm and perform actions of the shoulder joint independently after the operative procedure, thus reducing the functional status and quality of life. After the left shoulder hemiarthroplasty repair post due to inadequate rehabilitation, there was a failure in achieving the ranges and gaining back the strength of the muscles. The patient has a combined plan of action, which consists of pharmacological interventions along with physiotherapy rehabilitation. The physiotherapy protocol consists of goals like using electrical muscle stimulation, activation exercises of muscles, strengthening protocol, stretches, and counselling. By the end of the physiotherapy treatment, the patient showed significant progress in re-establishing the ranges and enhanced muscle strength, which resulted in a positive self-boost along with improved functional independence quotient, thereby increasing quality of life.

Physiotherapy Management in the Case of Primary Peritoneal Serous Carcinoma With Lower Segment Cesarean Section: A Case Report.

This case report presents the medical path of a 24-year-old female patient, who had undergone lower (uterine) segment cesarean section (LSCS) while facing complications of having several diagnoses at the same time, including primary peritoneal serous cancer, sexually transmitted disease (STD), and IgM-positive dengue. The prevention and treatment of STDs require an integrated approach due to the persistent problems they provide in the global healthcare system. In India, there is a high birth rate, which makes LSCS a common treatment. The combination of dengue fever, STDs, cancer care, and such issues related to women's health emphasizes the necessity of specialized interventions to reduce the risk of problems both during and after pregnancy. A sophisticated, multidisciplinary approach to postoperative care is required due to the confluence of these disorders, with physiotherapy and rehabilitation serving as a crucial treatment approach. The patient received breathing exercises along with core strengthening exercises. For relaxation, Benson's relaxation technique was used. Significant improvement was seen in the patient's muscle strength and quality of life post rehabilitation.

Respiratory Muscle Strength and Aerobic Performance Among Chronic Obstructive Pulmonary Disease (COPD) Patients: A Correlational Study.

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, yielding various respiratory symptoms and categorized under several descriptors: early, mild, young, pre-COPD, and preserved ratio impaired spirometry. COPD is synonymous with symptoms such as dyspnea and cough, in addition to others like exercise intolerance, which result from respiratory muscle weakness. Therefore, the emergence of respiratory strength assessment tools for such patients is not surprising. However, evidence is limited regarding the impact of respiratory muscle strength on the physical performance of COPD patients. Therefore, this study employs the MicroRPM device (Medikart HealthCare Systems Pvt. Ltd., Delhi, India) to measure maximum inspiratory and expiratory pressure utilizing mouth pressure. Methodology We recruited a total of 40 patients for the study. All patients received a thorough assessment for hemodynamic stability and were categorized according to the Global Initiative for Chronic Obstructive Lung Disease criteria of COPD. The patients then underwent a training session for the MicroRPM device. We took each patient's inspiratory and expiratory pressure measurements, then determined their six-minute walk distance and modified the Borg scale rating. Results We observed no significant correlation between maximum inspiratory pressure (Pimax) and six-minute walk distance (r=-0.023, p=0.890) or modified Borg scale (r=-0.044, p=0.788); additionally, the correlation between maximum expiratory pressure (Pemax) and modified Borg scale was not significant (r=-0.192, p=0.235). However, the correlation between Pemax and six-minute walk distance was both negative and significant (r=-0.384, p=0.014). Conclusion Based on our results, respiratory muscle strength can influence the aerobic performance of COPD patients.

Effect of Yogasanas Versus Gaze Stability and Habituation Exercises on Dizziness in Vestibular Dysfunction.

BACKGROUND: Dizziness is a typical manifestation of vestibular pathologies. Clinical studies have shown that it affects 1.82% of young adults to more than 30% older adults. Habituation and compensation are some traditional rehabilitation protocols. OBJECTIVE: Yoga is also known to have a significant effect on vestibulopathy. Hence, a need arises to compare the above two maneuvers. MATERIALS AND METHODS: Participants were recruited (n = 32) after screening using the Dix-Hallpike and head impulse test. They were then divided into two groups (n = 16). The first one, Group A, received yogasanas, and the second one, Group B, received gaze stabilization and habituation exercises for 4 days a week for 3 weeks. Pre- and post intervention outcome measures were taken using the motion sensitivity quotient (MSQ) score and Dizziness Handicap Inventory (DHI) scale. RESULTS: In reducing symptoms of dizziness, the between-group comparison shows that Group A has shown greater improvement (12.37% ±1.43%) in MSQ and Group B has shown greater improvement (16.12 ± 3.56) in DHI. Within-group comparison shows that both the interventions are effective in reducing symptoms of dizziness (P < 0.05). CONCLUSION: Both gaze stabilization along with habituation exercises and yogasanas are effective in improving the symptoms of dizziness in patients with peripheral vestibular dysfunction. When compared between the groups, yogasanas had a superior hand in the MSQ score, whereas gaze stabilization and habituation exercises had a superior hand in the DHI scale.

Instrument assisted soft tissue mobilization in adhesive capsulitis: A randomized clinical trial.

INTRODUCTION: Shoulder adhesive capsulitis is a common pathology in middle aged population, physical therapy being the mainstay treatment for it. Various conventional treatment modalities have been proven to help in this condition. Instrument Assisted Soft Tissue Mobilization (IASTM) is a considerably new technique, which is being used widely for various sports related injuries for a faster recovery. This study proposes to evaluate the effect of IASTM as an added treatment for improving pain, range of motion and functional ability in patients with adhesive capsulitis. METHOD: 30 shoulders were randomly allocated into two groups- Group A (IASTM + conventional treatment) and Group B (conventional treatment). Treatment was given for 12 sessions, 3 sessions per week for 4 weeks. Participants were evaluated pre treatment, post 6th session and post 12th session. Outcome measures was Numerical Pain Rating Scale, Shoulder Pain And Disability Index, Shoulder Range of Motion, Apley's scratch test. RESULTS: Pain and Disability scale had shown improvement within the group only. However, in experimental group significant improvement was seen in active and passive mobility including functional performance. CONCLUSION: IASTM along with conventional protocol was able to improve mobility and function among adhesive capsulitis patients.

Beliefs about low back pain: Status quo in Indian general population.

BACKGROUND: Low back pain (LBP) is a major public health problem and is the leading musculoskeletal cause of disability. Various bio-behavioral factors which can be associated with disability due to LBP have been identified. When considering these factors associated with LBP, beliefs that people hold are among the most important factors to consider. OBJECTIVE: To find out the prevalence of LBP among the general population and to investigate their beliefs towards LBP. METHODS: A cross-sectional survey of the general population was conducted. Demographic information and information on beliefs regarding low back pain was gathered from 921 individuals. The respondents were asked to rate their agreement with 7 statements, corresponding to Deyo's 7 myths. RESULTS: 75% of the population reported lifetime prevalence of LBP. Regarding the beliefs about LBP, general population exhibited diverse attitudes. Out of 7 myths explored, 3 myths were found to be dead and buried in more than 50% of the sampled population. However, 4 out of 7 myths still exist among the population. CONCLUSIONS: Prevalence of Low Back Pain was found to be high among the general population sampled and also myths regarding LBP still exist among them.

Effect of locomotor training on motor recovery and walking ability in patients with incomplete spinal cord injury: a case series.

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.