Self-reported musculoskeletal pain, headache, jaw pain and swallowing dysfunction in a sample of young Saudi adults who stutter.

Objectives: To report the prevalence of musculoskeletal pain, headache, jaw pain and difficulty in swallowing among people who stutter (PWS). METHODS: The cross-sectioal study was conducted from October 3, 2021, to March 21, 2022, after approval from the ethics review committee of King Khalid University, Abha, Saudi Arabia, and comprised adult people who stutter belonging to different regions of Saudi Arabia. They were divided into five groups based on stuttering severity as estimated by Stuttering Severity Instrument-4. Data was collected on musculoskeletal pain in different body areas using a questionnaire.. Data ws analysed using SPSS 22. RESULTS: Of the 101 Arabic-speaking subjects, 63(62.4%) were males and 38(37.6%) were females. The overall mean age was 27±7 years (range: 18-39 years). The largest group was of subjects with moderate severity of stuttering 31(30.6%); 21(68%) males and 10(32%) females. The increase in number of musculoskeletal pain locations was related to the severity of stuttering (p<0.05). The most common musculoskeletal pain sites were the lower back 31(31%), neck 26(26%) and shoulder 26(26%). Frequent headaches and difficulty chewing hard food due to jaw pain were reported by 49(49%) and 22(22%) participants, respectively (p<0.05). Swallowing difficulty was reported by 9(9%) participants (p>0.05). CONCLUSIONS: Widespread chronic musculoskeletal pain of low intensity was found to be common among people who stuttered, and the number of pain locations was positively related to stuttering severity.

Intrarater Reliability Of Cervical Range Of Motion Device Among Adults With And Without Chronic Non-Specific Neck Pain.

Objective: To evaluate the intrarater reliability of the cervical range of motion device among adults with and without chronic non-specific neck pain. METHODS: The analytical, cross-sectional study was conducted from January to March 2019 at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, and comprised healthy adults with no neck pain in the preceding 6 months in Group A, and adults of either gender with chronic non-specific neck pain for >3 months in Group B. The two groups were further divided into age groups 21-30 years, 31-40 years and 41-50 years. A cervical range of motion device was used to measure the range of flexion, extension, right and left lateral flexion and right and left rotation of all the subjects. The measurements were taken by a single tester on day-1 and day-3 to assess the intrarater reliability. Data was analysed using SPSS 26. RESULTS: Of the 60 subjects, there were 30(50%) in each of the two groups. Within the groups, there were 10(33.3%) subjects in each of the 3 age subgroups. Overall, there were 27(45%) males and 33(55%) females. In Group A, the intraclass correlation coefficient values for all cervical ranges were between 0.81 and 0.99, whereas in Group B, the values ranged from 0.64 to 0.88. The intraclass correlation coefficient values yielded good to excellent agreement in both groups (>0.75) except for left lateral flexion in Group B (p=0.64), and all the values were statistically significant (p<0.05). Conclusion: There was good to excellent intrarater reliability of cervical range of motion device in adults with and without chronic non-specific neck pain.

Effectiveness Of Neuro Mobilisation On Pain, Range Of Motion, Muscle Endurance And Disability In Cervical Radiculopathy: A Systematic Review.

Objective: To assess the effects of the neural mobilisation technique on mobility, pain and disability in cervical radiculopathy patients, and to assess the functional activity level. METHODS: The systematic review was conducted from January 5 to July 5, 2022, and comprised search on Medline, PEDro, Cochrane Library and Embase databases for randomised controlled trials involving patients diagnosed with cervical radiculopathy that were published in the preceding 10 years in the English language. The search terms were divided into four classes by using the guideline for systematic reviews of trials of interventions in the Cochrane neck and back groups and related spinal disorders. Data wasretrieved afterthe studies were subjected to quality assessment and risk of biasness. RESULTS: Of the 1563 studies initially found, 8 (0.51%)were reviewed.Nomatter the approach ordosage used,manual therapy was successful in treating cervical radiculopathy symptomsin all investigations. Conclusion: A multimodal strategy incorporating neural mobilisation appears to be the most successful short-term technique.

Acute effects of muscle vibration on elbow joint position sense in healthy young men: A randomized trial.

BACKGROUND: The study aimed to investigate and compare the acute effects of 2 local vibration frequencies (63 Hz vs 42 Hz frequencies) applied to the biceps brachii muscles on the elbow joint position sense (JPS) in healthy young men. METHODS: A 3-arm parallel-group design with randomization of participants was used. Forty-five healthy young men aged 19 to 30 years were randomly assigned to 3 groups: to receive 63 Hz (n = 15) in experimental group 1 (EG1) or 42 Hz (n = 15) in experimental group 2 (EG2) or sham vibration in the control group (n = 15). Participants in the EG1 and EG2 received 5 bouts of 1-minute vibration exposure to the biceps brachii muscle, with a 1-minute rest between the bouts. In control group, sham vibration was applied with the same duration and interval as in EG1 and EG2. The active elbow joint position error was selected as an outcome measure to assess elbow JPS. The target angle and the angle reproduced were measured using a Universal Goniometer. The difference between the target and the reproduced angles was calculated to determine active elbow joint position error. Measurements were made before the vibration application and right after it. RESULTS: No statistically significant difference was observed in the JPS of the elbow joint over time in any group (P = .625). No statistically significant differences were observed between the 33 groups in the JPS of the elbow (P = .075). CONCLUSION: There was no acute effect of vibration of the biceps brachii muscle at 63 and 42 Hz on active elbow JPS in healthy adults.

Corrigendum: Effects of breathing re-education on endurance, strength of deep neck flexors and pulmonary function in patients with chronic neck pain: A randomised controlled trial.

[This corrects the article DOI: 10.4102/sajp.v78i1.1611.].

Intrarater and interrater reliability of the dynamic gait index in post stroke patients with eye movement disorders.

BACKGROUND: The Dynamic Gait Index (DGI) is a useful tool that has been evaluated for its reliability in patients with vestibular disorders, elderly people and, in chronic stroke population. Present study was aimed to evaluate the intrarater and interrater reliability of the DGI to measure dynamic balance and gait performance in stroke patients with eye movement disorders. METHODS: A sample of 30 stroke patients suffering from eye movement disorders were recruited. Two Physical therapists assessed the intrarater and interrater reliability of the DGI in two testing sessions three days apart. In the later session, two raters assessed the patients' performance simultaneously on the DGI. The reliability was calculated using the intra-class correlation coefficient (ICC2, 1). Standard error of measurement (SEM) and minimal detectable change (MDC95) at 95% confidence interval were also calculated. A significance level was set at p-value <0.05. RESULTS: The (ICC2, 1) for intrarater and interrater reliability of total DGI scores was 0.86 and 0.91 respectively. While (ICC2, 1) for intrarater and interrater reliability of individual items ranged from 0.73 to 0.91 to 0.73-0.93, respectively. The (SEM) and (MDC95) for intrarater reliability of total DGI scores were 0.76 and 2.10, respectively. Corresponding values for interrater reliability were 0.62 and 1.71, respectively. CONCLUSIONS: The DGI is a reliable tool for evaluating the dynamic balance and gait performance in stroke patients with eye movement disorders. This tool showed good to excellent intrarater and interrater reliability of total DGI scores and moderate to good intrarater and interrater reliability of individual items of the DGI.

Short-term effects of tactile stimulation of facial skin on hamstring muscle flexibility in healthy young males.

BACKGROUND: Inhibition of the suboccipital muscle group is shown to increase the flexibility of hamstring muscles. Reversely, stretching of the hamstring muscles is shown to change the pressure pain thresholds over the masseter and upper trapezius muscles. There appears to be a functional link between the neuromuscular system of the head and neck, and lower extremities. The present study aimed to investigate the effect of tactile stimulation of facial skin on hamstring flexibility in healthy young males. METHODS: A total of sixty-six participants participated in the study. Hamstring flexibility was measured by the sit and reach (SR) test in long sitting and the toe touch (TT) test in standing before and after two minutes of facial tactile stimulation in the experimental group (EG) and after rest in the control group (CG). RESULTS: In both groups, significant (P<0.001) improvement was observed in both variables, i.e., SR (from 2.62 cm to -0.67 cm in EG and from 4.51 cm to 3.52 cm in CG) and TT (from 2.78 cm to -0.64 cm in EG and from 2.42 cm to 1.06 cm in CG). When both groups were compared, a significant (P=0.030) difference was observed between EG and CG in postintervention values of SR only. Greater improvement was observed in the SR test in EG. CONCLUSIONS: Tactile stimulation of facial skin improved hamstring muscle flexibility. This indirect mode of increasing hamstring flexibility can be taken into consideration while managing individuals with hamstring muscle tightness.

Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial.

OBJECTIVE: The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability. METHODS: It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons. RESULTS: There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05). CONCLUSIONS: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy. TRIAL REGISTRATION: RCT20190325043109N1.

Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial.

Purpose: Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy. Methods: A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used. Results: Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann-Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25. Conclusion: Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.

Effects of breathing reeducation on cervical and pulmonary outcomes in patients with non specific chronic neck pain: A double blind randomized controlled trial.

OBJECTIVE: The purpose of this randomized controlled trial was to study effects of breathing reeducation in the treatment of patients with non specific chronic neck pain. METHODS: A total of sixty eight eligible patients with chronic neck pain were randomly allocated to breathing reeducation (BR) group (n = 34) and routine physical therapy (RPT) group (n = 34). Clinical outcomes were neck pain measured through visual analogue score, cervical active range of motion through CROM device, strength of neck muscles through hand held dynamometer and endurance of neck muscles measured through craniocervical flexion test. The neck disability was measured through neck disability index (NDI) and pulmonary outcomes such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio were measured through Spirolab 4. The outcomes were assessed at baseline and at 4 and at 8 weeks from baseline. RESULTS: There were significant improvements in the BR group compared with the RPT group (P = 0.002) for cervical flexion, extension (P = 0.029), endurance (P = 0.042), strength of neck flexors (P <0.001), neck extensors (P = 0.034). Likewise there was a significant change in NDI (P = 0.011), FEV1 (P = 0.045), FVC (P <0.001), and FEV1/FVC ratio (P <0.001) in the BR group compared with the RPT group. The cervical side flexion and rotation showed no significant difference in breathing reeducation group with p > 0.05. CONCLUSION: Breathing reeducation combined with routine physical therapy is an effective treatment in patients with non specific chronic neck pain. TRIAL REGISTRATION: IRCT 20200226046623N1, https://www.irct.ir/trial/46240.

Effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders: a randomized controlled trial.

BACKGROUND: Impaired vision is one of the commonest and most disabling consequence following stroke. Among all visual impairments, eye movement disorders are found in 70% of stroke patients which include nystagmus, strabismus, gaze palsies, disconjugate eye movements and cranial nerve palsies. They have a wide ranging impact on balance and activities of daily livings by creating difficulties in maintaining normal alignment and appropriate movement of eyes. The purpose of this study was to examine the effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders. METHODS: This study is a randomized controlled trial and was conducted in the University of Lahore Teaching Hospital from May 2019 to October 2020. A sample of 64 patients was recruited and randomly allocated into experimental and control group. 32 patients in experimental group were treated with visual scanning exercises along with task specific approach and 32 patients in control group were treated with task specific approach alone. Pre and post assessment of balance and activities of daily livings was assessed on BERG BALANCE SCALE and BARTHEL INDEX SCALE at baseline and at 4th week. RESULTS: Intra-group analysis of BERG BALANCE SCALE in experimental group showed statistically significant result (p < 0.05) in all items except in items 4, 13 and 14 respectively. Intra-group analysis of BERG BALANCE SCALE in control group showed statistically significant result (p < 0.05) in items 3, 5, 8 and 12 respectively, whereas remaining all items showed statistically insignificant result. Intra-group analysis of BARTHEL INDEX SCALE in experimental group showed statistically significant result in all items (p < 0.05) except in items 9 and 10 respectively. Intra-group analysis of BARTHEL INDEX in control group showed statistically significant result (p < 0.05) in items 1, 3, 4 and 8 respectively whereas remaining all items showed statistically insignificant result. Inter-group analysis showed statistically significant result in total scores of BERG BALANCE SCALE (p = 0.000) and BARTHEL INEX SCALE (p = 0.033). CONCLUSION: Visual scanning exercises along with task specific approach were found to be more effective in comparison to task specific approach alone. TRIAL REGISTRATION: Trial registration number: [IRCT20190717044237N1], trial registration date: 10/11/2019.

Effect of static and dynamic jaw positions on postural stability among people with blindness.

BACKGROUND: In comparison with the people with normal sight, the mean center of gravity (COG) velocity is significantly higher among blind people. A strong relationship has been shown between jaw and neck sensorimotor and postural control. The purpose of this study was to determine the effect of different static and dynamic jaw positions on postural stability among subjects with blindness. METHODS: Postural stability was measured as COG velocity in 39 blind subjects under the following five conditions: resting jaw (natural jaw position with no instructions, control), open jaw (teeth of both jaws slightly apart), clenched jaw (teeth tightly closed across each other), chewing (a standard bolus of gum at the natural palace), and tongue position (positioned behind the upper incisors) while standing on firm and foam surfaces. RESULTS: The mean COG velocity while standing on the firm surface during resting, open jaw position, clenched jaw position, chewing, and tongue positions were 0.54, 0.50, 0.44, 0.59, and 0.46 deg/s, respectively. The mean COG velocity while standing on the foam surface during resting, open jaw position, clenched jaw position, chewing, and tongue positions were 1.42, 1.23, 1.10, 1.14, and 1.06 deg/s, respectively. Compared to the firm surface, the COG velocity was significantly higher on the foam surface in all five conditions (p < .001). In the comparison between the conditions, there were no significant differences in either the firm or foam surface in all five conditions (p > .05). CONCLUSION: People with blindness behave in the same way as sighted subjects on firm and foam surfaces. However, changes in static and dynamic jaw positions do not affect postural stability among them.

Effects of breathing re-education on endurance, strength of deep neck flexors and pulmonary function in patients with chronic neck pain: A randomised controlled trial.

Background: People with chronic neck pain show decreased endurance and strength of cervical muscles with compromised respiratory function. There is little evidence that improvement in breathing function of people with neck pain can help in enhancing cervical muscle strength and pulmonary function. The objective of this our clinical trial was to examine the effects of breathing re-education combined with physiotherapy on endurance and strength of deep neck flexors, and pulmonary function in patients with chronic neck pain. Methods/design: In this double blind randomised clinical trial, 30 patients with chronic neck pain (25-50 years old) were randomly allocated to two groups. Group A, physiotherapy (n = 15), and Group B, breathing re-education (n = 15). The duration of intervention was eight weeks with treatment five days a week. The endurance was measured with the craniocervical flexion test, strength with a handheld dynamometer (Baseline USA) and pulmonary functions with the Spiro lab 4 (USA) at baseline, at week four and at week eight of the intervention. Discussion: There was a significant between group improvement in the strength of deep neck flexors and forced vital capacity (FVC) in Group B p = 0.0001 and p = 0.0200 (p ˂ 0.05) respectively. Intergroup comparisons showed no significant differences for endurance, cervical extensor strength, Forced Expiratory Volume in one second (FEV1), and FEV1/FVC percentage. Conclusion: Our study concluded that breathing re-education combined with other physiotherapy management is effective for improving the strength of neck flexors and increasing FVC in people with chronic neck pain. Clinical implication: Breathing re-education may be part of physiotherapy management in patients with chronic neck pain. Trial Registration: Iranian Registry of Clinical Trials, IRCT20200226046623N1, https://www.irct.ir/trial/46240.

Inter-rater reliability of pressure biofeedback unit among individuals with and without chronic low back pain.

Objectives: To determine the inter-rater reliability of pressure biofeedback unit among individuals with and without chronic low back pain. Methods: This cross-sectional survey was conducted from February 2021 to March 2021 at the Physiotherapy Department of the Sindh Institute of Physical Medicine and Rehabilitation. Sixteen subjects which were recruited with and without chronic low back pain.(CLBP). During the test, abdominal drawing in movement was monitored by measuring a change in pressure detected in PBU. Each test was performed once by two trained assessors with period of seven days. Reliability indices of Pressure Biofeedback (PBU) measures including the Intraclass correlation coefficient [ICC] and Band Altman plot were analyzed. Results: This study found an intra-class correlation coefficient (ICC) = 0.94 [95% confidence interval (CI) (0.37, 0.99] for inter-rater reliability in healthy individuals, and an ICC of 0.97 (95% CI 0.97, 0.98) for inter-rater reliability in CLBP. The interrater agreement (Limits of Agreement-LOA=5.92, -3.9 mmHg) in CLBP and the interrater agreement (LOA=5.75, -3.25 mmHg) in healthy individuals were within the limits of agreement on 95% of occasions. Conclusion: Pressure Biofeedback Unit has showed excellent inter-rater reliability in measuring Transverse Abdominis muscle activity for individuals with and without chronic LBP.

Level of disability and associated factors with musculoskeletal disorders among supermarket cashiers.

OBJECTIVES: This study aimed to determine the severity of symptoms and the level of disability or difficulty associated with MSDs in the neck, shoulders, upper limbs, lower back, and lower limbs as well as the factors associated with MSDs. MATERIAL AND METHODS: This investigation collected demographic, health (36-Item Short Form Survey [SF-36]), and occupational related-factors for supermarket cashiers through the administration of several questionnaires, including the Oswestry Disability Index (ODI), Disabilities of the Arm, Shoulder and Hand (DASH), Neck Disability Index (NDI), Lower Extremity Functional Scale (LEFS), and Numeric Rating Scale (NRS) for pain. RESULTS: One hundred ninety-three supermarket cashiers participated in this study. The mean scores for disability levels included NDI (M±SD 18.62±14.57), ODI (M±SD 20.74±13.89), DASH (M±SD 15.08±13.90), and LEFS (M±SD 63.06±14.24). Regression analyses demonstrated the existence of significant relationships between the experience of MSDs and several other factors, including the number of working days per week, the preferred working position, marital status and the need for awkward positions. CONCLUSIONS: The results indicate MSDs that signified a mild disability level among young participants. The number of working days per week, the preferred working position, the need to assume awkward positions, and marital status were significantly associated with MSDs. The findings indicated the need for preventive to avoid or minimize the prevalence of MSDs among supermarket cashiers. Int J Occup Med Environ Health. 2022;35(4):407-23.

Effects of breathing re-education on clinical outcomes in patients with nonspecific chronic neck pain.

The present study evaluated the effectiveness of breathing re-education with routine physical therapy. This mixed method study was conducted at the District Headquarter Hospital Faisalabad, Faisalabad from April 2020 to July 2020. Fourteen participants (6men and 8 women) with chronic neck pain were recruited over a 16-week period and were equally divided into breathing re-education and routine physical therapy groups. The mean age of the patients was 38.48±5.92 years. Feasibility outcomes were recruitment, randomisation and retention rates of the participants. Clinical outcomes assessed for full trial were neck pain, cervical ROM, strength and endurance of neck muscles, quality of life and pulmonary functions. Outcomes were measured at baseline, fourth and eighth weeks. All the participants completed all the treatment sessions. No adverse events were reported. The breathing re-education group showed significant improvement in clinical outcomes. The results of this feasibility study provide supporting evidence for a future large-scale trial. Breathing re-education appears to be an effective treatment for chronic neck pain.

Effect of Maximally Relaxed Lying Posture on the Severity of Stuttering in Young Adults Who Stutter.

The current study was carried out with the aim of investigating the effect of maximally relaxed lying posture on disfluencies in young adults who stutter. A total of 24 participants (17 males, seven females; mean age = 24.9 ± 6.2 years) with developmental stuttering were a part of the study. The participants were asked to perform spontaneous speaking and reading aloud tasks in standard sitting and maximally relaxed lying postures. The severity of stuttering for the studied postures was estimated by using the Stuttering Severity Instrument. The results on the Stuttering Severity Instrument showed that stuttering parameters improved during the maximally relaxed lying posture compared with the standard sitting position. The results are discussed in the light of motor control concepts. It is concluded that the maximally relaxed lying posture can facilitate improvement in stuttering scores during spontaneous speaking as well as reading aloud in young adults who stutter. Reduced stuttering scores in the maximally relaxed lying posture suggest that speech therapists can position participants in this position while treating people who stutter.

Self-Reported Musculoskeletal Disorders and Quality of Life in Supermarket Cashiers.

Supermarket cashiers face a significant amount of stress, including time constraints, mental pressure, and physical demands that require repetitive movements. The job description of a supermarket cashier involves work-related risk factors that may lead to musculoskeletal disorder (MSD) symptoms. This study aimed to investigate supermarket cashiers to determine the prevalence of MSD symptoms and their quality of life. Data were collected from a convenience sample of supermarket cashiers working in Saudi Arabia. Information included direct questions on pain in the previous 12 months, demographic data, and health- or occupation-related factors. Moreover, data was collected based on the 36-item short form survey (SF-36), and descriptive statistics were computed. A total of 193 supermarket cashiers participated in this study. The sample included 140 men (72.5%) and 53 women (27.5%), with a mean age of 27.2 ± 6.4 years. The majority of the participants (90%) had MSD symptoms in at least one body region, with the neck (66.84%) and lower back (65.80%) constituting the most prominent regions. The mean SF-36 scores were higher in participants without pain compared to participants with pain in all domains, except for the physical functioning domain. The high prevalence of MSD symptoms among young cashiers suggest the need for additional investigations to determine the risk factors of these disorders. Additionally, this study recommends preventive procedures to reduce the prevalence of MSD symptoms among cashiers.

Can jaw position affect the fine motor activity of the hand during writing?

BACKGROUND: Jaw and neck systems have been shown to be functionally related and changes in either system can modulate gross motor functions, such as posture control. It remains to be seen if any change in jaw position can affect fine motor skills. The objective of this study was to determine the effect of resting, open and clenched jaw positions on various handwriting parameters while standing on firm and unstable surfaces. METHODS: Handwriting samples were collected from 36 healthy male participants (age, 15-35 years) using a digitizer tablet (WACOM Intuos 4) with noninking pen in the resting, open and clenched jaw positions while standing on firm and unstable surfaces. The measured handwriting parameters included duration, vertical size, horizontal size, absolute size, average absolute velocity, and absolute jerk. Recordings and analyses were performed using NeuroScript MovAlyzeR software. RESULTS: All handwriting parameters varied among the resting, open, and clenched jaw positions on both the firm and unstable surfaces. However, based on statistical analyses, there were no significant differences in the handwriting parameters among three jaw positions on both surfaces (p > .05). CONCLUSION: This study revealed that all handwriting parameters varied among the resting, open, and clenched jaw positions on both the firm and unstable surfaces, showing that change in the jaw motor system may potentially affect the fine motor skills. However, on statistical analysis, there was no significant effect of 3 studied jaw positions on fine motor skills as seen on gross motor skills among healthy individuals.

Experiences of Overseas Trained Physical Therapists Working in Saudi Arabia: An Observational Study.

Background: Health professionals, including physical therapists (PTs), are known to migrate for better jobs, as well as for personal and professional development. However, this involves risks of maladjustment, discrimination, and exploitation. We conducted this study to investigate the experiences of overseas trained PTs in Saudi Arabia (SA) and their perceptions about physical therapy practice and problems regarding the profession in the country. Methods: A questionnaire and accompanying explanation of the study was sent to 175 members of the Saudi Physical Therapy Association (SPTA) working in SA who had been trained outside SA and had a minimum of one year of work experience before moving to SA. Results: One hundred and fifty (86%) respondents completed the questionnaire. Among the respondents, the majority had more than five years of work experience after moving to SA. While 54% of the respondents reported that they were satisfied with their work experiences in SA, the remaining respondents reported their dissatisfaction for various reasons. Conclusions: With the increase in aged population and rise in disability, the need for PTs has simultaneously increased in the health care sector around the world, including in SA. Until PTs of local origin are ready to fill the requirements, the services of PTs from other countries will be required in SA. Although the majority of respondents reported having positive work experiences in SA, the negative aspects and challenges faced by PTs in SA have also been highlighted in this study. These problems need to be addressed in order to promote the development of a better and more holistic approach to patient care.