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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 2 | Issue 1
Page Nos. 1-67

Online since Friday, July 3, 2020

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EDITORIAL  

COVID-19 pandemic: An emerging physical therapy paradigm p. 1
Deepa C Metgud, Renu Pattanshetty, Aarti Welling
DOI:10.4103/ijptr.ijptr_16_20  
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GUEST EDITORIAL Top

Pandemic of coronavirus infection p. 4
Gajanan S Gaude
DOI:10.4103/ijptr.ijptr_7_20  
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REVIEW ARTICLE Top

Microcurrent electrical nerve stimulation in dentistry: A narrative review p. 8
Rohini Sarnaik, Renuka Ammanagi, Sujata Byhatti
DOI:10.4103/ijptr.ijptr_77_19  
Application of electricity in the field of medicine is not a new invention. In fact, it has been used over the past 150 years ago to treat bone fractures. Electromedicine was not in much use, and it has been recently revived due to its therapeutic benefits. Electrotherapy modality, especially transcutaneous electrical nerve stimulation (TENS), is traditionally used for a pain relief and also frequently used modality in the management of dental-related pain. However, microcurrent electrical therapy which is fairly a new technology used for tissue repair along with electroanalgesia for a variety of clinical conditions has been less explored in dental practice microcurrent electrical nerve stimulation (MENS) uses theoretically negligible amount of current at cellular level in relieving pain and promoting accelerated healing of damaged and inflamed tissue, which makes it as an efficient treatment modality in the management of pain with least number of side effects than drugs in chronic situations. It is also proposed that MENS is a superior modality in the treatment of masticatory muscle pain due to its electroanalgesia and tissue repair action. Hence, this article briefly reviews the application, effects, and side effects of MENS compared to traditional TENS.
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ORIGINAL ARTICLES Top

Effect of libra balance board exercises versus pilates on dynamic balance, gait, and quality of life in stroke subjects: A randomized clinical trial p. 14
Neeraja Vijay Deshmuk, Jeba Chitra
DOI:10.4103/ijptr.ijptr_34_19  
Background and Objectives: Stroke survivors are more prone for sensorimotor impairments such as dynamic balance and gait disabilities resulting in physical disabilities, striking a major socioeconomic burden on the family and society, if the goals of the rehabilitation are inappropriate. The present study aimed to compare the effect of Libra balance board exercises and Pilates exercises on dynamic balance, gait, and quality of life in subacute and chronic stroke patients. Materials and Methods: The present study was a randomized clinical trial that included 34 individuals, 17 in each group with subacute and chronic stroke in the age group of 40–65 years. All the patients having Brunnstrom voluntary control grades 3–5. Intervention included Libra balance board exercises and Pilates exercises for 30 min, five sessions per week over a period of 4 weeks. Patients were assessed at the baseline using Berg Balance Scale, Dynamic Gait Index, Activity-specific Balance Confidence Scale, and Stroke-specific Quality of Life Scale and reassessed after 4 weeks. Results: There was statistical significance in all the outcome measures in both the groups with P < 0.0001. However, Berg balance score showed statistical significance (P ≤ 0.001) in Group A with P < 0.05 when compared between the two groups. Conclusion: The study concluded that both Libra balance board exercises and Pilates exercises were beneficial in the enhancement of dynamic balance, gait, and quality of life in patients with subacute and chronic stroke
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Awareness and perception of physiotherapy among senior students of selected secondary schools in a South-Western community of Nigeria p. 19
Samuel Olufemi Bolarinde, Temitope Victor Owoyemi, Ayodeji Obaya, Michael Nanimebila
DOI:10.4103/ijptr.ijptr_2_20  
Context: Physiotherapy plays a significant role in health care system. The pursuit of career in physiotherapy depends largely on the information available to the students about the practice of physiotherapy. Aims: To investigate the level of awareness and perception of physiotherapy profession among senior secondary school students. Settings and Design: The cross-sectional study recruited 259 senior class students in selected secondary schools in Owo local government area of Ondo-state, South-western Nigeria. Materials and Methods: A self-administered questionnaire adapted from similar studies was used to obtain information on level of awareness and perception of physiotherapy. Statistical Analysis Used: Data were summarized using mean, standard deviation, frequency and percentiles. Results: 71.0% of participants were aware of physiotherapy profession. 76.8% were aware that physiotherapy can be studied in University while others believed it can be studied in polytechnic (3.9%), college of education (6.6%) and technical schools (5.4%). 45.9% knew about adequate subject combination for gaining admission to study physiotherapy while 54.1% did not know about adequate subject combination. The overall knowledge score of <48.0% among the participants indicated inadequate knowledge about physiotherapy practice, treatment modalities and specialties. Conclusions: Participants in this study demonstrated a high level of awareness about physiotherapy. The knowledge level of the participants about the practice of physiotherapy, treatment modalities and specialties other than orthopedic remains inadequate. Professional body of Physiotherapy should create a detailed career talk in secondary school to increase the level of awareness and knowledge about the practice of physiotherapy, treatment modalities and specialties.
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Effect of self- care exercises in forward head posture on craniovertebral angle and craniocervical flexion endurance: A pilot study p. 25
Peeyoosha Gurudut, Aarti Welling, Ashma Chodankar
DOI:10.4103/ijptr.ijptr_48_19  
Background: Forward head posture (FHP) is the most frequently attained attitude of the head associated with rounded-shoulder posture (RSP) that leads to muscle imbalances. This needs to be corrected to prevent neck pain. Self-care exercises are home exercises that work positively for the prevention of the secondary effects of RSP. Aims: The aim of this study is to determine the effects of two self-care exercises, namely Bruegger's postural relief position and quadruped track cervical brace exercise in the management of asymptomatic FHP in terms of craniovertebral angle (CVA) and craniocervical flexion endurance (CCFE). Settings and Design: A single-group pre–post study design was conducted on physiotherapy volunteer student population of the Health Science University, Belagavi. Materials and Methods: Fifteen participants with asymptomatic FHP (<44° of CVA) were recruited. They have prescribed the two self-care exercises (Bruegger's postural relief exercise and quadruped track cervical brace exercise), twice a day for 10 consecutive days. The outcome measures were the degree of FHP in terms of CVA and strength of deep cervical flexor muscles by CCFE test that were assessed pre- (day 1) and posttreatment (day 10). Results: The mean age of the participants was 23.00 years (standard deviation = 1.56). The comparison of pre- and postintervention scores for CVA and CCFE outcomes demonstrated a statistically significant improvement (P < 0.0001). Conclusions: The two self-care exercises showed an effective reduction of CVA and increased deep cervical flexor strength in FHP. Once learned by the patients, the exercises can be self-administered and can be performed independently by the patients.
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Correlation between interscapular pain during the breast development phase, cup size, and thoracic index in adolescent school girls from 13 to 16 years of age p. 31
Ashwini Bulbuli, Saima Shaikh
DOI:10.4103/ijptr.ijptr_54_19  
Background: Physical symptoms associated with poor posture due to heavy breast leading to neck, shoulder, interscapular, and back pain are prevalent. Occurrence and persistence of musculoskeletal pain among children and adolescents may result in the development of chronic pain symptoms in adulthood. Hence, this study was conducted to determine if any correlation existed between interscapular pain, cup size, and thoracic index in adolescent school girls during the breast development phase. Materials and Methods: A cross-sectional descriptive study was conducted where 2000 school girls aged between 13 and 16 years were screened to identify if they had interscapular pain. Two hundred of them were screened positive, of which 54 were excluded, as they carried a backpack weighing more than that recommended for their gender and age and one for psychological distress. One hundred and forty-five participants were evaluated for the intensity of pain using Numeric Pain Rating Scale, cup size using inch tape, and thoracic kyphosis using flexible curve ruler based on which thoracic index was calculated. Results: About 10% had interscapular pain, of which 0.68% had mild, 68.96% moderate, and 30.34% had severe pain. Twenty-seven participants had cup size A, 107 had B, and 11 had C size. Nearly 37.24% had normal, 55.86% had less than normal, and 6.89% had more than normal thoracic index values, respectively. There was a correlation between interscapular pain, cup size, and thoracic index. Conclusion: We conclude that no statistically significant correlation exists between interscapular pain, cup size, and thoracic index.
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Effect of sciatic nerve neurodynamic sustained natural apophyseal glides on individuals with pelvic crossed syndrome: A randomized controlled trial p. 35
Sneha Pradeep, Anand Heggannavar, Santosh Metgud
DOI:10.4103/ijptr.ijptr_40_19  
Background: Pelvic crossed syndrome (PCS) is a common predisposing factor of low back pain. If left untreated, PCS could result in various spinal and lower-limb pathologies which would hinder an individual's functional abilities and affect their quality of life. Aims: The study aimed to evaluate the effect of sciatic nerve neurodynamic sustained natural apophyseal glides (SNAGs) along with a stretching-strengthening protocol on individuals with symptomatic PCS. Settings and Design: This study was conducted in a tertiary care center; this was a randomized controlled trial. Materials and Methods: Forty-two individuals were randomly allocated to control group (conventional physical therapy) and experimental group (sciatic nerve neurodynamic SNAGs along with conventional physical therapy) using envelope method. The outcome measures – pressure pain threshold, degree of lumbar lordosis, modified Thomas test, finger-to-floor test, and Modified Oswestry Disability Questionnaire (MODQ) were obtained from the participants on day 1 and posttreatment on day 6, respectively. Both the groups received the treatment for 45 min per session for 6 consecutive days. Statistical Analysis Used: Parametric dependent t-test was applied through R software 3.5.1. Results: Intragroup analysis revealed statistically significant changes in all outcome measures in both the groups. Statistically significant changes were observed in the intergroup analysis of all the outcome measures (P < 0.0001) in favor of the experimental group except degree of lumbar lordosis (P = 0.78) and MODQ (P = 0.27). Conclusion: Sciatic nerve neurodynamic SNAGS when given along with conventional therapy resulted in significant and superior improvement as compared to conventional therapy alone in patients with symptomatic PCS in terms of pain sensitivity and flexibility.
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Relationship between home environment and psychomotor development in Urban and Rural children: A cross-sectional study p. 41
Shruti Ramchandra Murthy, Snehal Dharmayat
DOI:10.4103/ijptr.ijptr_50_19  
Background and Purpose: Development of children has shown to be influenced by various factors, one of them being the environment. There are diverse cultural practices across different settlements that play a role in conditioning the child's pattern of development. A home serves to be the primary environment in which every child grows in, which influences development. This study intends to determine the relationship between home environment and psychomotor development in children and to compare the psychomotor development in children of urban and rural areas. Materials and Methods: A door-to-door survey was conducted for the recruitment of participants from urban and rural areas as per inclusion criteria. Two hundred children were evaluated, 100 each from urban and rural areas. Home environment assessment made using Affordances in the Home Environment for Motor Development (AHEMD) scale versions as per the age of the child. The developmental assessment was done using the Developmental Assessment Scales for Indian Infants (DASII). Results: A significant positive correlation was found between AHEMD and motor quotient (MoQ) (r = 0.2892) and mental quotient (MeQ) (r = 0.3940) on DASII. There was a significant difference in the AHEMD scores of urban and rural participants (P = 0.0038). The MoQ was between urban and rural participants which was statistically significant. A significant difference (P = 0.0006) was found in MeQ scores between urban and rural participants. Conclusion: The present study concludes that there is a positive correlation between the environment at home and psychomotor development in children. The urban children had better mental and motor development scores than the rural children, although both the urban and rural children showed average development.
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Effect of functional strength training versus proprioceptive neuromuscular facilitation on balance and gait in patients with diabetic neuropathy p. 47
Janhavi Jagdish Atre, Suvarna Shyam Ganvir
DOI:10.4103/ijptr.ijptr_76_19  
Background: Diabetic neuropathy is one of the major complications of diabetes mellitus, which mainly affects lower limbs in patients with diabetes. Thus, taking into consideration, the debilitating effects of diabetic neuropathy, strength training (ST) is advocated for these individuals to prevent further deterioration. There is meager literature supporting the effectiveness of proprioceptive neuromuscular facilitation (PNF) in individuals with diabetic neuropathy. Objective: The objective of this study was to compare the effectiveness of functional ST and PNF on balance and gait in patients with diabetic neuropathy. Materials and Methods: Thirty-two participants with diabetic neuropathy were recruited and randomly allocated to PNF group and FST group. PNF group received PNF lower limb patterns and functional ST group received functional ST for 5 days a week for 8 weeks. Balance and gait were evaluated using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) respectively. Statistical Analysis: Within group and between groups, data were analyzed using the Wilcoxon signed-rank test and Mann–Whitney U–tests respectively. Results: A significant improvement in the values of BBS and DGI was observed in PNF group (P < 0.05) as well as FST group (P < 0.05). When PNF and FST were compared, there was a statistically significant improvement in the FST group for both BBS (P = 0.02) and DGI (P = 0.03). Conclusion: Functional ST is more effective than PNF in improving the clinical measures of balance and gait in patients with diabetic neuropathy.
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Immediate and Short-Term Effect of Virtual Reality Training on Pain, Range of Motion, and Kinesiophobia in Patients with Cervical Spondylosis p. 55
Madhumanti Mukherjee, Nilima Bedekar, Parag K Sancheti, Ashok Shyam
DOI:10.4103/ijptr.ijptr_73_19  
Context: Neck problems are the second most reported musculoskeletal condition. Neck injuries and pain are the common and frequent causes of absenteeism and disability. These conditions have a negative impact on individuals' activities of daily living. Aim: The aim of this study is to compare the effectiveness of virtual reality training (VRT) along with conventional physiotherapy over conventional treatment alone on pain, range of motion (ROM), and kinesiophobia in the patients with cervical spondylosis. Setting and Design: This was a randomized control trial done at the tertiary care hospital, Pune, India. Materials and Methods: Forty-four participants were randomly allocated using the chit method to the conventional group (n = 22) and conventional plus VRT group (n = 22). VRT was given using an immersive virtual reality headset. The outcomes assessed were pain using the Numeric Rating Scale and cervical ROM (all movements) using universal goniometer and kinesiophobia. Pain and ROM were assessed on the immediate (day 1) and short-term (day 3) basis while kinesiophobia was assessed only on day 3. Statistical Analysis Used: Statistical analysis was performed using the Statistical Package for the Social Sciences software version 16.0. Results: Intragroup analysis revealed a statistically significant difference in the immediate and short-term assessment in both the groups for all the variables (P ≤ 0.05). However, intergroup analysis revealed that VRT is effective in alleviating pain in the immediate (P = 0.02) and short-term (P = 0.00) analysis and improving rotation (left rotation [ P = 0.04]; right rotation [ P = 0.01]) and side flexion (left side flexion [ P = 0.00]; and right side flexion [0.01]) ranges. The results were insignificant for flexion, extension, and kinesiophobia. Conclusion: The present study concluded that both the protocols are effective in reducing pain and improving ROM. VRT was better in reducing pain than conventional treatment on the immediate and short-term basis. However, VRT group was not effective in improving ROM on an immediate basis. Both the treatment methods were equally effective in reducing kinesiophobia.
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CASE REPORT Top

A case report on novel integrated kinetic chain correction protocol for early osteoarthritis knee: A preventive prospect p. 61
Peeyoosha Gurudut, Aarti Welling, Rima Jaiswal
DOI:10.4103/ijptr.ijptr_53_19  
Current literature states the use of management protocols that target the entire kinetic chain of the lower limb rather than managing only the affected joint. An integrated therapist-designed corrective protocol may work effectively through changes make as in the myofascial kinetic chain on knee osteoarthritis (OA). In this case report, the effect of a novel integrated protocol for knee OA in a 49-year-old woman was studied. The outcome measures included pain intensity, functional affection, kinesiophobia, frontal plane projection angle, range of motion, gait velocity, and cadence. The patient was treated for 15 sessions over a period of 3 weeks along with physical agent application and exercises that targeted from core to ankle. Significant improvements were observed in the outcome measures postintervention. This novel structured protocol has proved to be effective in minimizing the early symptoms of knee OA.
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CONTINUING PHYSIOTHERAPY EDUCATION Top

E-Learning in health professionals' education p. 66
Nayana Hashilkar
DOI:10.4103/ijptr.ijptr_14_20  
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