<p>Osteonecrosis of hip or Avascular necrosis (AVN) of hip, is the vascular disruption of the hip joint lead to the death of the femoral head. AVN is more common in males than in females. Most Commonly clinically presents as the insidious onset of pain around the hip and restricted range of motion of hip Join that lead to patients have a problem in wait bearing and during walking. Patients cannot walk properly.</p><p>Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. D-dimer elevation is often observed in patients with acute COVID-19 due acute lung injury itself or due thromboembolic complications that occur frequently in COVID-19. Thromboembolism can damaged nearby blood vessels and reduce blood flow to bones lead to AVN can developed. Those who are suffering from Mild to Moderate COVID-19 they take more amount of corticosteroids during the acute phase of infection. Use of high-dose corticosteroids, such as prednisone can increase lipid levels in the blood, reducing blood flow. Due to Increase Lipid Levels and more Thromboembolism the cases of AVN Hip is increasing day by day.</p><p>Physiotherapy Can be used for relief of symptoms of Pain and Restricted ROM of hip joint. It can be help to prevent of disease progression and Improvement of functional activity and ADL. Physical therapy treatment focuses on exercises to maintain joint mobility and strengthen the muscles around the affected hip joint. Exercises will focus on the muscles of the hip and thigh but will also include exercises for the core area as they play a large supporting role. To improve functionality, it is important to implement endurance training and coordination training in a more advanced stage of the therapy.</p>

<p>Low back pain is defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain. This profoundly affects daily activities and frequently impairs functional tasks. Low back pain (LBP) affects nearly 60-80% of people throughout their lifetime.One of the suspected etiologies of LBP is lack of hamstring flexibility. Sitting at a desk all day can cause tightness and a shortening of hamstring muscles, and therefore leads to back pain.</p><p>The hamstring group refers to the posterior thigh muscles and act as strong flexors of the knee and weak extensors of the hip.</p><p>Hamstring group of muscles includes <strong>semitendinosus</strong>, <strong>semimembranosus</strong>, and <strong>long and short heads</strong> of the <strong>biceps femoris</strong>. All together flex the knee but the short head of biceps femoris alone extends the hip.Blood supply from the perforating branches of the deep femoral artery ,also known as the profunda femoris artery.</p><p>We might be wondering how hamstring tightness could result in back pain. The body is interconnected, and prolonged sitting without stretching can cause the hamstrings to constrict and shorten. These muscles originate from the ischial tuberosity of the pelvis . The pelvis tilts posteriorly as a result of tight hamstrings As the pelvis and the lumbar vertebrae work together, when the pelvis tilts posteriorly, the lumbar vertebrae are forced to flex forward. The pelvis, lumbar spine, and surrounding muscles are put under more tension and strain as a result of this. Blood supply to the hamstrings will be reduced if they are tight. Therefore, muscles are working with less capacity, which results in low back pain.</p><p>The predominance of tightness is greater in female 96% than in male 4%. Its incidence is high in university students from 18-25 years.</p><p><strong>Stretch to reduce the pain .The stretches can gradually lengthen and reduce tension in the hamstring muscle, and in turn reduce stress felt in the lower back.</strong></p>

<h3>INTRODUCTION: -</h3><hr class="mt-0" /><p>An epidemic of lower back pain affects millions of individuals globally. One significant cause of this pain stems from disc problems in the lumbar spine, such as disc herniations, degeneration, or nerve impingement. To accurately diagnose these disc issues, healthcare professionals rely on various physical assessments. Among the most reliable tests is the Slump Test.</p><h3>What is the Slump Test?</h3><hr class="mt-0" /><p>The Slump Test is a physical examination technique used to assess neural tension, particularly in the lumbar spine. It’s often employed by physiotherapists, chiropractors, and physicians to evaluate nerve root compression or disc pathologies. When someone has pain radiating from their lower back into the legs, known as sciatica, the Slump Test can provide valuable insights into whether a lumbar disc problem is the source of the pain.</p><p>Why is the Slump Test Important for Lumbar Spine Disc Diseases? Disc diseases in the lumbar spine, such as herniated or bulging discs, can compress the spinal nerves. This compression leads to a range of symptoms, including pain, numbness, and tingling sensations, particularly down the legs. The Slump Test helps in pinpointing the source of these symptoms, especially when they are related to nerve involvement due to disc displacement.</p><p>The test mimics a slouched posture, which stretches the spinal cord and nerve roots. If a disc problem exists, this stretch aggravates the pain or discomfort, confirming the involvement of lumbar disc issues.</p><h3>How is the Slump Test Performed?</h3><hr class="mt-0" /><p>The Slump Test is typically done in a clinical setting. Here’s how it works:<br /><ul><li><p>Patient Position: The patient sits on the edge of the examination table with their thighs supported, knees flexed, and feet dangling.</p></li><li><p>Posture Slumping: The patient is asked to slump or round their back while keeping their head upright. This posture places stress on the spinal structures.</p></li><li><p>Neck Flexion: The patient is then instructed to flex their neck by bringing the chin toward the chest.</p></li><li><p>Leg Extension: With the patient in this slumped position, one leg is slowly extended by the clinician, which stretches the sciatic nerve and the nerve roots in the lumbar spine.</p></li><li><p>Response Assessment: The patient is asked if they feel any reproduction of their symptoms, such as pain, numbness, or tingling down the leg. If so, it indicates the likelihood of lumbar nerve root irritation, often due to a disc herniation or other disc pathology.</p></li></ul></p><h3>Interpretation of Results:</h3><hr class="mt-0" /><p>Positive Test: If the patient experiences a reproduction of their typical symptoms, particularly sciatica-like pain, while performing the test, it’s considered a positive result. This strongly suggests neural involvement due to lumbar disc issues.</p><p>Negative Test: If the patient does not experience any symptoms or discomfort, the result is negative. This could indicate that the disc is not the cause of the pain, or that the symptoms are stemming from other sources like muscular tension or joint dysfunction.</p><h3>Clinical Relevance of the Slump Test:</h3><hr class="mt-0" /><p>The Slump Test is a useful tool in diagnosing lumbar disc problems because it reproduces the mechanical stresses that occur when the lumbar spine’s nerve roots are irritated. It provides valuable direction to clinicians in determining the next steps for treatment, including physiotherapy, chiropractic adjustments, or even more invasive interventions like injections or surgery.</p><h3>Limitations of the Slump Test:</h3><hr class="mt-0" /><p>Although the Slump Test is valuable, it’s not the only tool for diagnosing lumbar disc disease. It must be combined with other assessments such as:</p><p>MRI or CT scans to confirm disc herniations or degenerations. Range of motion tests to rule out joint-related issues. Reflex testing to evaluate the extent of nerve involvement. Additionally, the Slump Test is a subjective test based on the patient’s response, so it requires skilled interpretation from the clinician.</p><h3>Conclusion:</h3><hr class="mt-0" /><p>The Slump Test is a crucial direction-providing test in diagnosing disc diseases of the lumbar spine. It helps clinicians assess nerve root compression due to disc herniation or bulging, which is often the source of lower back pain radiating down the legs. As part of a comprehensive physical assessment, the Slump Test can offer clear guidance for treatment strategies, ultimately helping patients recover from lumbar spine issues and regain their quality of life.</p><p>For anyone experiencing lower back pain or sciatica-like symptoms, consult a healthcare provider to assess the possibility of disc-related problems using diagnostic tools like the Slump Test. Early detection can lead to more effective treatments and a quicker recovery.</p>

<p>Soccer is a physically demanding sport that requires players to be in excellent physical condition to perform at their best. However, the risk of injuries is always present due to the high-intensity nature of the game. To address this issue, FIFA developed the FIFA 11+ injury prevention program, aimed at reducing the risk of injuries among soccer players of all levels.</p><p>The FIFA 11+ program consists of a series of exercises designed to improve strength, balance, agility, and flexibility while also targeting key risk factors for injuries, such as incorrect movement patterns and muscle imbalances. By incorporating these exercises into their regular training routine, players can significantly reduce their chances of sustaining common injuries like muscle strains, ligament tears, and sprains.</p><p>The FIFA 11+ program emphasizes dynamic stretching and muscle activation exercises to prepare the body for soccer matches, increasing flexibility, improving proprioception, and reducing injury risk.</p><p>In addition to the physical benefits, the FIFA 11+ program also emphasizes the importance of good technique and proper body mechanics to prevent injuries. By teaching players how to move efficiently and safely on the field, the program helps reduce the risk of overuse injuries and repetitive strain.</p><p>Overall, the FIFA 11+ injury prevention program is effective in reducing the incidence of injuries among soccer players. By incorporating this program into their training regimen, players can improve their performance on the field while also safeguarding against the physical toll that the sport can take on their bodies. Whether you&#39;re a professional athlete or a casual player, following the FIFA 11+ program can help keep you healthy, strong, and injury-free while playing the beautiful game of soccer.</p>

<p>As people age, their immune systems vary significantly, resulting in differences in how older men and women respond to flu vaccines. According to research, elderly men&#39;s and women&#39;s immunological responses to influenza vaccine vary significantly.</p><p>Hormonal differences between men and women have a significant role in these discrepancies. Estrogen, which is found in greater amounts in women, has been demonstrated to improve immunological response to vaccinations, particularly flu injections. According to studies, women may have a stronger immunological response to vaccination than males because of hormonal influences.</p><p>Furthermore, age-related immune system changes, known as immunosenescence, influence how older people respond to immunizations. In general, older persons have a weakened immune system, which leads to a worse response to vaccination. However, research suggests that women may maintain greater immune function as they age than males, perhaps leading to a more effective response to flu vaccines.</p><p>In addition, variations in the way older men and women react to flu vaccines might be attributed to hereditary factors. It is known that individual reactions to vaccination are influenced by differences in genes linked to immune function and vaccine response. Variations in vaccination effectiveness between older men and women have been identified; these discrepancies may be partially explained by genetic differences.</p><p>In summary, whereas vaccinations against influenza protect against the disease for older men and women alike, there are notable variations in the immune responses of these populations. Comprehending these distinctions is crucial for refining vaccination plans for senior citizens and creating specialized methods to increase vaccination efficacy in this demographic.</p>

Volume-1, Issue-1

<p>Sarcopenia is a condition characterized by the loss of muscle mass, strength, and functionality that often occurs with aging. This age-related muscle wasting can have significant impacts on an individual's quality of life, leading to decreased mobility, increased risk of falls, and overall reduced ability to perform daily tasks.</p><p>While some muscle loss is a natural part of the aging process, sarcopenia goes beyond the typical decline in muscle mass that occurs with age. It is often associated with factors such as decreased physical activity, poor diet, hormonal changes, and chronic illnesses. Additionally, sarcopenia can be exacerbated by conditions like inflammation, insulin resistance, and oxidative stress. The consequences of sarcopenia can be far-reaching. Loss of muscle mass can lead to a decrease in metabolism, making it more difficult to maintain a healthy weight. It can also impact balance and coordination, increasing the risk of falls and fractures. Furthermore, reduced muscle strength can affect overall mobility and independence, potentially limiting an individual's ability to live an active and fulfilling life.</p><p>Preventing and managing sarcopenia requires a multifaceted approach. Regular physical activity, particularly resistance training, is essential for preserving muscle mass and function. Adequate protein intake is also crucial for supporting muscle maintenance and repair. Additionally, maintaining a healthy weight, managing chronic conditions, and ensuring adequate vitamin D and calcium levels can help mitigate the effects of sarcopenia. Early detection and intervention are crucial for addressing sarcopenia, enabling healthcare providers to assess muscle mass and strength, and implementing targeted interventions like exercise programs.</p><p>Sarcopenia, a significant health concern, can significantly impact physical function and well-being, particularly in older adults. Effective prevention and management can be achieved through a healthy lifestyle and regular exercise.</p>

<p>An exercise routine may feel time consuming — but no matter what type of workout you choose, or how busy your schedule is, it’s critical that you don’t skip warming up before your workout, or cooling down afterwards. You’d be surprised how many people decide they don’t need to warm up before working their core, or that it’s fine to skip their cool-down after jogging on the treadmill.</p><p>In most cases, it’s not because people hate doing the warm up or cool-down, but because they want to save time. Unfortunately, it’s not just the main part of your workout that matters — and the people who skip the processes before and after a workout may be doing more harm to their bodies than they realize.</p><div class='text-center mb-3'><img src='/assets/img/vol-2-issue-2-a2.png' /></div><h3>Why Warming Up and Cooling Down Is So Important</h3><p>A warm-up and a cool-down both involve doing exercises at a lower intensity and slower pace, which improves your athletic performance, prevents injuries, and helps with recovery from exercise.</p><p>Warm up activities include light jogging, or cycling slowly on a bike. Warming up before exercise prepares your cardiovascular system for physical activity, by increasing the blood flow to your muscles, and raising the temperature of your body. It also helps to lower the risk of getting injured — when your muscles are adequately warmed up, the movements, stretches, and strain you put on them during your workout is less severe. This also minimizes muscle soreness.</p><p>Warm up activities include light jogging, or cycling slowly on a bike. Warming up before exercise prepares your cardiovascular system for physical activity, by increasing the blood flow to your muscles, and raising the temperature of your body. It also helps to lower the risk of getting injured — when your muscles are adequately warmed up, the movements, stretches, and strain you put on them during your workout is less severe. This also minimizes muscle soreness.</p><p>Cooling down after your workout aims to gradually bring your heart rate and blood pressure to its normal level — the level it was at prior to exercising. During your workout, your heart rate has been pumping much higher than it does normally, and it’s important to ease it back down instead of abruptly stopping all motion. Cooling down also helps to regulate your blood flow, which is especially important for people who undertake endurance sports such as long distance running. To safely cool down, gradually reduce the pace of your exercise during the last 10 minutes of your session — for example, if you’re jogging, reduce your pace to a brisk walk for the last 10 minutes.</p><h3>Benefits of Warming Up</h3><div><ul><li><p><strong>Improved Performance:</strong> Warming up improves your athletic performance in the following ways:</p></li><li><p><strong>Improved Blood Flow:</strong> Warming up for 10 minutes with an easygoing activity improves blood flowing to your skeletal muscles, and opens up blood capillaries. Your blood carries the oxygen needed for your muscles to function, so increasing your blood flow is one of the best things you can do to set your muscles up for a workout.</p></li><li><p><strong>Improved Oxygen Efficiency:</strong> When you do a warm-up exercise, oxygen is released from your blood more readily, and at higher temperatures. Your muscles demand higher amounts of oxygen while exercising, so it’s important to make this oxygen more available through a warm-up activity.</p></li><li><p><strong>Faster Muscle Contraction/Relaxation:</strong> Warming up with physical activity raises your body temperature, which in turn, improves your nerve transmission and muscle metabolism. The end result? Your muscles will perform faster and more efficiently.</p></li><li><p><strong>Injury Prevention:</strong> Warming up prevents injuries by loosening your joints, and improving blood flow to your muscles — making your muscles less likely to rip, tear, or twist in a harmful way during your workout. Stretching also helps prepare your muscles for the physical activities you’re about to perform.</p></li><li><p><strong>Mental Preparation:</strong> A side benefit of warming up is that your brain will become focused on your body and your physical activity as you go through the process. This focus will carry over into your training session to help you to improve your technique, coordination, and skill.</p></li></ul></div><h3>Benefits of Cooling Down</h3><div><ul><li><p><strong>Recovery:</strong> After intense exercise, lactic acid builds up within your system, and it takes time for your body to clear it out. Cooling down exercises (such as stretches) can aid this process of releasing and removing lactic acid, helping to speed up your body’s recovery post-workout.</p></li><li><p><strong>Reducing DOMS (Delayed Onset Muscle Soreness):</strong> While muscle soreness is to be expected after exercise, a significant amount of DOMS is very uncomfortable, and can prevent you from exercising in the future. A study performed by California State University found that moderate intensity cycling after strength exercise helped to reduce DOMS. Cooling down after exercise helps to alleviate excessive muscle soreness, keeping you more comfortable and allowing your body to bounce back before your next workout.</p></li></ul></div><h3>What Happens If You Don’t Properly Warm Up and Cool Down?</h3><ul><li><p><strong>Increased Risk Of Injury:</strong> Over 30% of injuries seen by sports medicine clinics are skeletal muscle injuries — which can be easily prevented by warming up and stretching.</p></li><li><p><strong>Blood Pooling:</strong> If you stop exercising abruptly without cooling down, your muscles will suddenly stop contracting vigorously. This can cause blood to pool in the lower extremities of your body, leaving your blood without as much pressure to be pumped back to the heart and brain. As a result, you may dizzy and lightheaded, and you may even faint.</p></li><li><p><strong>Increased Stress On Cardiovascular System:</strong> Warming up helps you to gradually increase your heart rate and breathing to a level that will be able to meet the demands of your workout. If you start exercising at a strenuous level without warming up first, you will place unnecessary stress on your heart and lungs.</p><p>The next time you feel like you can’t spare the extra 10 minutes to cool down after running, think carefully about the effect it will have on your body. Those 10 minutes certainly seem worth it when you consider that you’re helping prevent injuries to your body, improve your performance, and aid your post-workout recovery.</p></li></ul>

<h3 class='mb-0'>INTRODUCTION:</h3><hr class='mt-0' /><h4>LOWER CROSSED SYNDROME</h4><p>Lower crossed syndrome (LCS) is a musculoskeletal imbalance characterized by specific patterns of muscle weakness and tightness that crosses between the dorsal and ventral sides of the body. It is also known as a pelvic crossed syndrome. In lower crossed syndrome, the thoraco-lumber extensors are tight in dorsal side and there are also tightness in illiopsoas on the other side. While there are weakness in abdominals muscles and gluteus maximus muscles.</p><p>The result of chain reaction that the pelvis tips forward on the frontal plane, flexing the hip joints and producing lumber lordosis and stress at L5-S1 with pain and irritation. A further stress commonly appears in the sagittal plane in which quadratus lumborum tightness and gluteus maximus weaken.</p><p>When this ‘lateral corset’ becomes unstable, the pelvis is held in increased elevation, accentuated when walking, resulting in L5-S1 stress in the sagittal plane. One result is low-back pain. The combined stresses described produce instability at the lumbodorsal junction, an unstable transition point at best.</p><p>Failure of coactivation due to persistent tonic activity results in faulty neurodevelopment of the motor system. This eventually promoting lower crossed syndromes.</p><h4>FLATFOOT</h4><p>Flatfoot deformity defined by the loss of medial longitudinal arch of the foot where it contacts or nearly contacts the ground. There are two types of flatfoot deformity. The first type is rigid or congenital flatfoot and second type is acquired or flexible flatfoot.</p><p>Flexible flatfoot may result from tibial or femoral torsion, coxa vara, a defect in the subtalar joint, or injury to the posterior tibial tendon.</p><p>The need of the study is to evaluate the incidence low back pain in Physiotherapy students. To evaluate incidence of lower cross syndrome and flat foot in low back pain subjects</p><h4>Design:</h4><p>A total 234 students both girls and boys between age group 18 to 24 years were screened by self administered questionnaire form, from which 82 students having low back pain are taken into consideration. Each student were underwent for assessment of tightness of illopsoas with use of thomas test, tightness of errector spine ( LUMBER FLEXION ROM) with use of modified modified schober’s test , strenght of abdominals and gluteus maximus with use of manual muscle testing, flatffot with using of nevicular drop test.</p><h4 class='m-0'>METHODS:</h4><hr class='mt-0' /><h5>MEASUREMENT OF EERECTOR SPINE THIGHTNESS:</h5><p>Modified Modified schober’s test: Ask the subject to standing postion. Place a first mark at a middline point on the sacrum that is level with the posterior superior illiac spine( this mark will be over the spinous process of S2). Make a second mark 15 cm above the middline sacral mark. Align the tape measure between the superior and inferior marks. Ask the subject to bend forward as far as possible while keeping the knees straight. Maintain the tape measure against the individual’s back during the motion, but allow the tape measure to unwind to accommodate the motion. At the end of flexion ROM, note the distance between the two marks.(1)</p><h5>MEASUREMENT OF ABDOMINAL MUSCLE STRENGTH:</h5><p>The subject were placed in supine lying position with legs straight and fingertips lightly touching the back of the head ( Grade 5 ) , arm crossed over the chest ( Grade 4 ), arms outstretched in full extension above the plane of the body (Grade 3). For Grade 2 ,1 and 0 subject were placed in supine lying position with arm at sides. Knees flexed. Therapist stand at side of the table at level of patient’s chest to ascertain whether scapular clear table during test. Then ask the subject to lift the shoulders, and back off table, keeping the chin pointed to cilling. Patient flexes trunk through range of motion, lifting the trunk until scapulae clear the table. IF the patient has weak hip flexors, therapist should stabilize the pelvis by leaning across the patient on the forearms.(2)</p><h5>MEASUREMENT OF GLUTEUS MAXIMUS STRENGTH:</h5><p>The subject is ask to lie in prone with knee flexed 90 degrees, hip abducted and externally rotated. Therapist stand at leval of the pelvis on the side to be tested. Ask the subject to lift the thigh off the plinth as high as possible, while bending the knee. Place the hand for resistance over the posterior thigh just above the knee. The opposite hand may stabilize or maintain the alignment of the pelvis. Resistance is given in a straight downward direction. According to MRC grading the strength of gluteus maximus was graded.(2)</p><h5>MEASUREMENT OF ILLIOPSOAS MUSCLE TIGHTNESS:</h5><p>Ask the subject to lies supine. The examiner flexes one of the subject’s hips, bringing the knee to chest to flatten out the lumber spine and to stabilize the pelvis. The subject holds the flexed hips against the chest. If the is a no tightness, the hip being tested ( The straight leg) remains on the examining table. If the tightness is present, the subject’s straight leg raises off the table and muscle stretch end feel will be felt. If the lower limb is pushed down onto the table, the subject may exhibit an increased lordosis; again, the result indicate the positive test.(3)</p><h5>MEASUREMENT OF FLATFOOT:</h5><p>Ask the subject to relax sitting position. The examiner first measure the height of the navicular from the floor in the neutral talus position using the most prominant part of the navicular tuberosity and then measure the height of the navicular in normal relaxed standing. The difference is called navicular drop. Any measurement greater than 10 mm is considered abnormal.(3)</p><h5>RESULT:</h5><p>The study concludes that there is 35.04% students of physiotherapy college having low back pain. Out of that 73.17% students having a incidence of lower crossed syndrome and 6.09% students having a incidence of flatfoot.</p><p>The study concludes that there is a 5.98% students of physiotherapy college having low back pain since last one month. Out of that 78.57% students having lower crossed syndrome and 7.14% students having incidence of flatfoot.</p><h5>REFERENCES:</h5><div><ol><li><p>Cynthia C. Norkin, D. Joyce White (Fifth Edition)</p></li><li><p>Daniels and Worthingham's (First South Asia Edition)</p></li><li><p>David J. Magee (Sixth Edition)</p></li></ol></div>

<h3>ABSTRACT:</h3><p>The purpose of this study was to determine the underlying reason for occurrence of stroke in young craftsman and make him achieve his goal of performing activities of daily living independently post stroke. He underwent physiotherapy treatment for seven days while admitted in the ward where the exercises were given on the basis of impairments. The therapy was targeted to achieve his goal to return to his working routine and earn for the living for him as well as his family.</p><h4>Keywords</h4><p>Young stroke, Hemorrhage</p><hr/><h3 class='mt-4'>INTRODUCTION:</h3><p>The occurrence of stroke in young adults comprises of around 10-15% of total stroke in a year worldwide.1 Most of young strokes encountered are ischemic ones whereas very few of them are found to be hemorrhagic. Approximately 30-35% of young stroke cases are accounted to be hemorrhagic (Intracerebral and subarachnoid).2</p><p>Stroke is one of the leading causes of disability, morbidity and mortality in the world. People suffering from stroke have greater impact on family and social life. They are often employed, peaking at their careers, caring for the dependents in the family which is affected due to impairments persisting post stroke. Rehabilitation and recovery process for young stroke survivors differs from those in older adults. It involves restoring the person to his or her functional status before stoke as well as able to return to occupation.</p><p>Most of young stroke cases do not have known and usual etiologies. There many underlying possibilities not understood at time of onset such as developmental cardiac abnormalities, hematological disorders, chronic systemic inflammation and many others.3Many risk factors are also responsible for stroke in young adults such as drug abuse, contraceptive use, and hypertension.</p><p>Young stroke is a major cause of concern in developing countries such as India as they belong to earning strata of the society. This case study aimed at knowing the underlying pathology in a young stroke patient and rehabilitates him to a functional level so that he can join his job.</p><h3>CASE DESCRIPTION:</h3><p>A 26 year old male, craftsman by occupation, presented with history of loss of consciousness followed by regaining it after 2 mins while playing outdoors and was in usual state after that. Around 5 hours after this episode he had a syncope accompanied by involuntary movements and loss of consciousness. He was reported to have seizure episode and was admitted in ICU in local hospital. He underwent emergency intubation was on ventilator for a day and then weaned off.</p><p>He was suggested to shift in tertiary hospital care, where on the way he had a fall in ambulance but sustained no external injuries. After around 3 days, he had sudden onset of severe headache posteriorly and aching in nature, and sudden weakness of right hand and right leg characterized by inability to lift right arm and move right leg. He was immediately shifted to ICU and immediate medical care was taken. MRI investigations were done which revealed minimal Subarachnoid Hemorrhage (SAH) in bilateral parietal regions. He recovered from his weakness after around 7-8 hours after onset of weakness. He was then shifted to ward and referred for physiotherapy treatment.</p><p>The patient did not have any history of hypertension. He reported to have occlusion of varicose veins by thrombus about a year age which was resolved with allopathy medications for month followed by homeopathy medication for around 7 months. He did not report of having any addictions.</p><p>On examination by physiotherapy department, he had intact higher motor functions and speech with retention of memory about the subsequent events that occurred which led to the weakness. On observation he had stoop posture in sitting with protracted shoulders. The cranial nerves and sensation were intact, plantar reflex was up going on right side and deep tendon reflexes were normal (++) bilaterally. Tone was normal but there was some amount of weakness persisting in right lower extremity. Muscles such as hip flexors, abductors, extensors; knee flexors, extensors and dorsiflexors were graded 4 on doing MMT (Manual Muscle Testing) on right side. Balance was affected with fair dynamic balance in standing and good static balance. He could perform transitions such as supine to sit, sit to stand, and walk independently or requiring supervision at times. His baseline measurement of STREAM (Stroke Rehabilitation Assessment of Movement), TIS (Trunk Impairment Scale), Mini-BESTest scales were taken whose values were 56/70, 20/23, 10/28 respectively. He had difficulty in performing activities such as dressing, bathing and toileting activities and required minimal help of bystanders to perform these activities.</p><h3>INTERVENTION:</h3><p>The therapy aimed at strengthening of weak muscles and balance training to help him to achieve independence in performing activities of daily living.</p><p>Muscles such as shoulder flexors, abductors, elbow flexors, hip flexors and abductors, knee flexors and extensors, dorsiflexors were strengthened by attaching 1 kg weight cuff and moving the limbs in required direction. Weight bearing activities such as partial squats, single limb squats (weight bearing on right side) were done with 10 repetitions in 2 sets.</p><p>Balance training involved giving reach outs within base of support and out of base of support in sitting as well as standing. He was made to stand with narrow base of support for 30 seconds initially with eyes closed gradually after 6 days of regular training he could stand for 60 seconds in narrow base of support. Similarly single limb stance initially he could stand only for 15seconds with eyes closed on right leg, progression was made each day, and with training he could maintain balance for 45 seconds after 6 days of training.</p><p>Ambulation- He was made to walk on a straight line on 2nd day of reference, gradually the complexities were increased such as head turns during walking, altering speed while walking, taking turns, answering questions simultaneously (training for dual tasks). These activities were targeted so that while performing regular activities patient did not lose balance.</p><p>On 5th day of training he was trained with stair climbing initially with one step upwards with one leg followed by other leg on the same step with railings support. Progressively he was made to climb stairs with alternate stepping without railings support.</p><p>After 7 days of intervention, scales were again taken to know the amount of improvement with respect to recovery. The STREAM score was 70/70, TIS was 23/23, Mini-BESTest was 21/28 on the day of discharge from hospital.</p><p>He was given advised to avoid addictions, in case of similar episode to have emergency consultation to neurologist and regular compliance with neurologist was suggested as he was at high risk of developing similar episode.</p><h3>RESULTS:</h3><p>After 7 days of physiotherapy treatment the patient could balance while walking, reduced incidences imbalance when distracted while walking. He could perform activities such as dressing, bathing, and toileting independently without supervision of bystanders. He was ready to resume his job within few days and support the family.</p><h3>DISCUSSIONS:</h3><p>Functional prognosis represents one of the most important and meaningful aspects of outcome of disease. The patient almost recovered from the impairments suffered post stroke.</p><p>The patient did not have any history of long standing headache (migraine) indicating internal bleed. There is no history fall or trauma on head causing internal bleed. Symptoms such as severe headache and loss of consciousness in indicative of hemorrhage but pathology causing hemorrhage could not be understood.</p><p>SAH has high chances of neuroinflammation causing early brain injury and delayed brain deterioration including cellular and molecular events.4So it was necessary to make the patient aware of possible consequences such as reoccurrence of stroke.</p><h3>CONCLUSION:</h3><p>The case study reveals that conventional physiotherapy techniques and methods helped the patient achieve his goal of performing activities of daily living independently. The therapist ensured that the patient was counselled about his condition and had chances of further complication and to take appropriate preventive measures.</p><h3 class='mt-4'>REFRENCES:</h3><div><ol><li><p>Smajlović D. Strokes in young adults: epidemiology and prevention. Vascular health and risk management. 2015; 11:157.</p></li><li><p>B. S., Boden-Albala, B., Lin, I. F., & Sacco, R. L. (2002). Stroke in the young in the northern Manhattan stroke study. Stroke, 33(12), 2789-2793.</p></li><li><p>Bevan, H., Sharma, K., & Bradley, W. (1990). Stroke in young adults. Stroke, 21(3), 382-386.</p></li><li><p>Zheng VZ, Wong GK. Neuroinflammation responses after subarachnoid hemorrhage: a review. J Clin Neurosci. 2017 Aug 1; 42:7-11.</p></li></ol></div>

<p>In the dynamic field of women's health, physiotherapy stands as a beacon of holistic care, transcending the traditional confines of physical treatment. This discipline, enriched by insights from 'Obstetrics by Ten Teachers', 'Gynaecology by Ten Teachers', and 'National Guidelines for Quality Obstetrics and Perinatal Care', offers a well-rounded approach to health, particularly for pregnant women and those with gestational diabetes. This article delves into the intricacies of diet and nutrition, exercise, yoga, ergonomics, healthy habits, and personal hygiene, highlighting their collective impact on women's health.</p><h3>Diet and Nutrition : The Foundation of Women's Health</h3><p>Proper nutrition is a cornerstone of health, especially during the crucial phases of pregnancy and lactation. Women's bodies require a symphony of nutrients to support their own health and that of their developing babies. Key nutrients include calcium, crucial for bone health and a vital component in preventing osteoporosis; iron, essential for combating anemia, especially significant during menstruation and pregnancy; folate, a B-vitamin critical for preventing birth defects and aiding in fetal brain development; and vitamin D, vital for overall health and immune function.</p><p>A balanced diet, rich in fruits, vegetables, lean proteins, whole grains, and healthy fats, supports not just physical health, but also mental well-being. For those with specific conditions like gestational diabetes, diet plays a therapeutic role. A low-glycemic diet rich in fiber, lean protein, and healthy fats helps regulate blood sugar levels, ensuring both maternal and fetal health.</p><h3>Exercise and Yoga: Enhancing Physical and Mental Well-being</h3><p>Physical activity is a pillar of health, offering benefits that extend beyond weight management. Cardiovascular exercises, such as walking, swimming, or cycling, improve heart health and enhance circulatory efficiency. Strength training, often overlooked, is crucial for maintaining muscle mass and bone density, particularly important in preventing osteoporosis. Yoga, with its emphasis on flexibility, balance, and mental focus, offers a unique set of benefits. During pregnancy, yoga can alleviate common discomforts like back pain, enhance circulation, and prepare the body for childbirth through focused breathing and relaxation techniques. Moreover, the mental benefits of yoga, including stress reduction and mindfulness, contribute significantly to overall well-being.</p><h3>Ergonomic and Hygiene Practices for Optimal Health:</h3><p>Ergonomics, particularly in the context of women's health, involves designing work and home environments that support physical well-being. Proper ergonomic practices reduce the risk of musculoskeletal disorders, a common ailment among women due to their diverse roles and responsibilities. During pregnancy, ergonomic adaptations are essential to accommodate the changing body and prevent strain and injury.</p><p>In addition to ergonomics, personal hygiene plays a crucial role in women's health. Regular bathing, proper genital care, and appropriate menstrual hygiene practices are essential for preventing infections and maintaining overall well-being. This is particularly important during menstruation and pregnancy, when hormonal changes can affect the body's susceptibility to infections.</p><h3>Healthy Habits for a Balanced Life:</h3><p>Healthy habits form the bedrock of a balanced lifestyle. Quality sleep is essential for physical repair and mental clarity. Relaxation techniques and effective stress management are as important as physical health practices. Mental well-being, fostered through mindfulness and meditation, has a profound impact on overall health.</p><p>Hydration is another key aspect of healthy living. Drinking adequate water daily is crucial for bodily functions and can prevent common issues like urinary tract infections, which are more prevalent in women. Avoiding harmful habits such as smoking and excessive alcohol consumption is vital for long-term health and well-being.</p><p>In conclusion, the integration of physiotherapy with diet, exercise, ergonomics, healthy habits, and personal hygiene offers a comprehensive framework for enhancing women's health. This is especially important during transformative phases such as pregnancy and postpartum. The application of evidence-based practices, informed by authoritative sources, enables physiotherapists to make significant contributions to women's health, guiding them toward healthier, more balanced lives.</p><p>By understanding and addressing the unique needs of women at different life stages, physiotherapy can play a pivotal role in not just treating but also preventing a range of health issues. This proactive, holistic approach is the key to empowering women to take charge of their health and well-being.</p>

Volume-1, Issue-2

<h4>Background:</h4><hr class='mt-0' /><p>The term paralympic was considered as a pun combining paraplegic and olympic. Although it&#39;s origin is unclear, the term “Paralympic” is used to describe the Stoke Mandeville Games. The paralympic sport has grown and developed for the following three main reason</p><div><ul><li><p>Sports are an effective means of augmenting rehabilitation outcomes for people with disabilities.</p></li><li><p>People with disabilities have a right to participate in sports and should have the same opportunities as others.</p></li><li><p>Paralympic sport is ELITE, EXCITING AND INSPIRING.</p></li></ul></div><h4 class='mt-4'>History:</h4><hr class='mt-0' /><div class='history'><ul><li><p>1948 - First Stoke Mandeville Games</p></li><li><p>1949 - Second Stoke Mandeville Games</p></li><li><p>1956 - Third Stoke Mandeville Games</p></li><li><p>1957- The term “Paralympic” is to describe Stoke Mandeville Games</p></li><li><p>1960 - First Paralympic Games held in Rome</p></li><li><p>1964 - Second Paralympic Games held in Tokyo</p></li><li><p>1968 - Third Paralympic Games held in Israel</p></li><li><p>1972 - Fourth Paralympic Games held in Germany</p></li><li><p>1976 - Fifth Paralympic Games held in Canada</p></li><li><p>1980 - Sixth Paralympic Games held in Netherlands</p></li><li><p>1984 - Seventh Paralympic Games held in New York</p></li><li><p>1988 - Eighth Paralympic Games held in Seoul Korea</p></li><li><p>1992 - Ninth Paralympic Games held in Spain</p></li><li><p>1994 - Tenth Paralympic Games held in Norway</p></li><li><p>1996 - Eleventh Paralympic Games held in Atlanta</p></li><li><p>1998 – Twelfth Paralympic Games held in Japan</p></li><li><p>2000 - Thirteenth Paralympic Games held in Australia</p></li><li><p>2002- Fourteenth Paralympic Games held in Australia</p></li><li><p>2004 - Fifteenth Paralympic Games held in Greece</p></li><li><p>2006 - Sixteenth Paralympic Games held in Italy</p></li><li><p>2008 - Seventeenth Paralympic Games held in China</p></li><li><p>2010 - Eighteenth Paralympic Games held in Canada</p></li><li><p>2012 - Nineteenth Paralympic Games held in UK</p></li><li><p>2014 - Twentieth Paralympic Games held in Russia</p></li><li><p>2016 - Twenty first Paralympic Games held in Brazil</p></li><li><p>2018 - Twenty second Paralympic Games held in Russia</p></li><li><p>2020 - Twenty third Paralympic Games held in Korea</p></li><li><p>2022 - Twenty fourth Paralympic Games held in Japan</p></li><li><p>2024 - Twenty fifth paralympic Games are going to be held in France</p></li></ol></div><h4 class='mt-4'>Advent of Paralympics:</h4><hr class='mt-0' /><div><ul><li><p>It is commonly accepted that the Paralympic movement began in England in 1940’s. However, the concept of providing sports opportunities specifically for people with disabilities was pioneered by Sir Ludwig Guttmann.</p></li><li><p>Sir Ludwig Guttmann - Founding Father of the Paralympic Games.</p></li><li><p>Sir Ludwig Guttmann (1899-1980) was born into a Jewish family in Germany. He qualified as a medical doctor in 1924(MD) and began his lifelong specialization neurology and neurosurgery.</p></li><li><p>At Stoke Mandeville, Guttmann began a number of highly innovative methods of rehabilitation forpeople with spinal cord injury (SCI).</p></li><li><p>Chief among these was the inclusion of sport as an integral part of physical rehabilitation, as aninitiative. It ultimately lead to the establishment of the paralympic games. Sport as Rehabilitation</p></li><li><p>A hallmark of rehabilitation at Stoke Mandeville was that, patients were always encouraged to extend themselves physically - whether sitting up in bed during early rehabilitation from the unit, patients were expected to have high levels of physical independence.</p></li><li><p>As attractive as this game was for the patient, the use of the stick at the same time as propelling the wheelchair made the game unacceptably dangerous, and it was soon replaced by a variety of other sports, including archery, netball, javelin throw and snooker.</p></li><li><p>Guttman promoted sports as the most natural form of remedial exercise, restoring physical fitness, strength, coordination, speed, endurance and overcoming fatigue.</p></li><li><p>Guttman believed that sport was a vital means of achieving what he regarded as the ultimate aims of rehabilitation to make the spinally injured person as independent as possible and to restore him to his rightful place in social life.</p></li></ul></div><h4 class='mt-4'>Logo:</h4><hr class='mt-0' /><p>Official logo for the IPC (International Paralympic Committee) adopted in 2003. It comprises three agitos symbolising <strong>'spirit in motion'</strong> and <strong>'mind and body spirit'</strong>.</p><h4 class='mt-4'>Paralympic categories:</h4><hr class='mt-0' /><p>The five areas of resolution are that all paralympic systems of classification must be:</p><div class='history'><ul><li><p>Be consistent with the International Classification of Functioning Disability and Health (ICF)</p></li><li><p>Based on scientific evidence</p></li><li><p>Define eligible types of impairments</p></li><li><p>Define minimum impairment criteria</p></li><li><p>Classify impairments according to the extent of activity limitation caused</p></li></ul></div><p>Defining eligible types of Impairments: To date only ten types of Impairment have been eligible for Paralympic sports.</p><div class='history'><ul><li><p>Visual impairment</p></li><li><p>Impaired strength</p></li><li><p>Impaired range of movement</p></li><li><p>Limb deficiency</p></li><li><p>Leg length discrepancy</p></li><li><p>Hypertonia</p></li><li><p>Ataxia</p></li><li><p>Athetosis</p></li><li><p>Short stature</p></li><li><p>Intellectual impairment</p></li></ul></div><p>The above mentioned ten impairment types are eligible for various Paralympic sports; In order to compete in Paralympic sports, a person must be affected by at least one of the impairments listed above.</p><h4 class='mt-4'>Disability:</h4><hr class='mt-0'/><p>Those who are confirmed to a wheelchair, deaf, blind or missing a limb, those who have only one of a paired set of organs or those with behavioural, emotions and psychological disorders that substantially limit a major life activity are said to be disabled persons.</p><h4 class='mt-4'>Types:</h4><hr class='mt-0' /><div class='history'><ul><li><p>Amputee</p></li><li><p>Cerebral palsy</p></li><li><p>Spinal cord injury</p></li><li><p>Spina bifida</p></li><li><p>Polio</p></li></ul></div><h4 class='mt-4'>Biomechanics:</h4><hr class='mt-0'/><div><ul><li><p>The study of biomechanics of wheelchair propulsion played an important role in designing the equipment and improved athletic performance impact on wheelchair racing, basketball, rugby and handcycling.</p></li><li><p>Risks of mechanical over use are higher, due to overuse injuries, mobility can decrease.Neverthless high level sports performance is possible with the subsequent increases in physical fitness, health and mobility.</p></li><li><p>A properly fitted manual wheelchair should offer freedom and efficiency during propulsion.</p></li><li><p>The wheelchair users have been encouraged to use a more forward long smooth strokes during the propulsive phase.</p></li><li><p>Higher stroke frequencies have been shown to correlate to median nerve injury and lead to increased heart rate and cardio respiratory stress.</p></li><li><p>A racing chair used in combination with correct propulsion biomechanics canresult in an extremely efficient means of movement above and beyond all other hand rim sport.</p></li><li><p>A racing chair’s primary steering is however is controlled by the upper body&#39;s interaction with the front wheel, where pressure can be applied to handle the bars, which turn the front wheel from left to right.</p></li><li><p>The racing stroke as a technique where the extensive shoulder extension and abduction during the backswing lead to increased hand speed at the impact energy transfer phase.</p></li><li><p>There are a total of five phases</p><ol class='history'><li><p>Drive forward and downward</p></li><li><p>Push rim contact</p></li><li><p>Pushing through to the bottom of the push rims</p></li><li><p>Push off or fallow through</p></li><li><p>Elbow drive to the top</p></li></ol></li></ul></div><h4 class='mt-4'>In paraplegic:-</h4><hr class='mt-0' /><p>During the push phase:- triceps brachii, antero medial deltoid, pectoralis major are more active During the recovery phase:- subscapularis, supraspinatus, middle trapezius are more active In Quadriplegic:- Activation of pectoralis major seems to be more prolonged when compared to paraplegic</p><h4 class='mt-4'>Role of Physiotherapist in Paralympics:</h4><hr class='mt-0' /><p>It is interesting to find out how the physiotherapist involved in the Paralympics. The Olympic ambition will lead to an increase in the number of active sports participants, which will have both positive and negative consequences in the sense of more sports injuries, increase in costs as a result of sports injuries. This is where the role of the physiotherapist comes into play, which will become increasingly prominent in guiding sports participants.</p><h4 class='mt-4'>Muscles to be strengthened:-</h4><hr class='mt-0' /><div class='history'><ol><li><p>Shoulder elevators, depressors, flexors, adductors</p></li><li><p>Scapula elevators</p></li><li><p>Elbow flexors, extensors and Forearm supinators, pronators</p></li><li><p>Trunk mobilization</p></li><li><p>Pelvic rotators and elevators</p></li><li><p>Hip extensors, flexors and adductors</p></li><li><p>Knee flexors and extensors</p></li></ol><h4 class='mt-4'>Strength training benefits:</h4><hr class='mt-0' /><ul><li><p>Increase bone mineral density</p></li><li><p>Improve glucose metabolism</p></li><li><p>Avoid muscle loss</p></li><li><p>Reduce low back pain</p></li><li><p>Reduce resting blood pressure</p></li></ul> <h4 class='mt-4'>Trainings so vital:</h4><hr class='mt-0' /><ol><li><p>Range Of Movement (ROM) of all joints to prevent thrombosis, improve mobility and to gain strength</p></li><li><p>Mobility training for trunk, shoulder and pelvis</p></li><li><p>Resistive exercises practiced on the sound limb</p></li><li><p>Training for weight transfers, crutch walking, wheelchairs etc.</p></li><li><p>Chest exercises</p></li><li><p>Assessing the athlete’s ROM and strength</p></li><li><p>Training for single limb standing and balancing</p></li><li><p>Flexibility and strengthening programme</p></li></ol><p>Last but not least, lots of talking, boosting of the morale of the patient plenty of sympathy and psychological reassurance</p><h4 class='mt-4'>Physiotherapeutic modalities</h4><hr class='mt-0' /><ul><li><p>Ultrasound</p></li><li><p>TENS</p></li><li><p>Electric stimulation</p></li><li><p>LASER therapy</p></li><li><p>Soft tissue manipulation</p></li><li><p>Cryotherapy</p></li><li><p>Hot packs</p></li><li><p>Therapeutic exercises</p></li></ul></div><h4 class='mt-4'>Conclusion</h4><hr class='mt-0' /><p>Physical benefits:- General fitness, CVS conditioning, postural control, flexibility, muscle strength, balance</p><p>Psychological benefits:- Impaired motivation, self confidence, self esteem, competitive spirit Physical Medicine &amp; Rehabilitation (PM&amp;R) in Christian Medical College (CMC) Vellore, Tamil Nadu, India</p><p>The history of PM&amp;R in India is intertwined with the personal story of Dr.Mary Verghese. The tragedy of a road traffic accident that rendered her paraplegic inspired her to establish a department of PM&amp;R in Vellore and a Rehabilitation institute, the first of its kind in the country. The field of the physical medicine and rehabilitation which deals with the comprehensive care ,for persons with disability, to make them physically independent.</p><h4 class='mt-4'>Elite Paralympic Athlete’s:</h4><hr class='mt-0' /><p>Aiming at success from wheelchairs. Spinal cord injury might have changed their lives competitively, but for young men who were treated and rehabilitated at PM&amp;R, CMC Vellore, overcame the challenges to make a difference. Spinal cord injuries posed numerous challenges for patients as they would loose sensation in the legs and would not be able to move. The department introduced wheelchair sports into the rehabilitation programme not on a competitive basis, but to expose the patients to sports and make them fit.</p><p>Mr .Venkatachalam who underwent rehabilitation at PM&amp;R Vellore had won the athletic events of discuss throw, shotput race in the Paralympics 2015 .He was devastated following the SCI and did not know what he was getting to do for the rest of his life on a wheelchair. But being part of sports has energised him, made him fit and has won the recognition of being a Paralympic player.</p><h4 class='mt-4'>References:</h4><hr class='mt-0' /><div class='history'><ol><li><p>Introduction - vanlandewjick Hand Book of sports medicine The Paralympic Athelete</p></li><li><p>History of the Paralympic movement - Bailey,s (2007) Athelete first</p></li><li><p>Rehabilitation through the sport - Carvalhoj&amp;Forkas.A(2005)</p></li><li><p>Classification in Paralympics sports - Tweedy, SM &amp; Bourke.J(2009)</p></li><li><p>Biomechanics- Boninger,N.L,Koontz,et al (2005)</p></li><li><p>Aimimg at success from wheelchairs - article 140284123.ece(2016)</p></li><li><p>Pushrim of wheelchair - Boninger,et al(2005)</p></li><li><p>PM&amp;R- Dr.Mary verghese pioneer of Rehab Vellore (2017)</p></li><li><p>Role of Physiotherapist - Annual plan (2021)Disabled sports Netherlands</p></li><li><p>Role of physiotherapist in Paralympics - Foundation for history of physiotherapy foundation (2021)</p></li></ol></div>

<p>The presence of a physical therapist in the Neonatal Intensive Care Unit (NICU) has been found to be influential in reducing physical impairments and limitations in infants, as well as in educating the family on how to provide optimal care for their newborn. Two terms coined in the NICU that should be learned are ‘Early intervention’ & ‘Developmental supportive care’.</p><h4>EARLY INTERVENTION:</h4><hr class='mt-0'/><p>It is a prevention-focused program that aims to support the well- being of preterm infants and their families. It involves identifying and providing early support to children who are at risk of poor outcomes and can help prevent problems from occurring or address them before they worsen. Early intervention programs are often implemented soon after birth, when the infant's brain is still developing and interventions are most likely to have the greatest impact.</p><h4 class='mt-4'>DEVELOPMENTAL SUPPORTIVE CARE:</h4><hr class='mt-0'/><p>It is a practice model that aims to reduce stress and pain for babies, parents, and healthcare professionals in a neonatal unit. It also aims to provide babies with developmentally appropriate sensory experiences and maximize their neurological development. This approach can help reduce long-term cognitive and behaviouralproblems. <br/><br/>As a Physiotherapist in NICU, we can do....</p><p><strong>Nesting: </strong>In utero, the fetus is confined to an enclosed space with well-defined boundaries to support the development of physiological flexion. The boundaries allow a fetus to extend his arms and legs to meet resistance and subsequently recoil his extremities into a gently flexed position. This physiological flexion is necessary for the development of normal posture movement control. In the Nesting technique, the babies are protected inside a nest made out of rolls of cloth. It improves the comfort of neonates. The rolls can help them to feel boundaries and they can push up against the sides of the rolls comforting them (Fig-1). Nesting can be done while the infant is in the NICU and placed on a monitor that helps to ensure that the baby is physiologically stable. Because of the fragility of preterm infants, most NICUs have adopted a minimal handling and stimulation approach for very immature infants.</p><p><strong>Swaddling: </strong>Swaddling is the art of snugly wrapping a baby in a blanket for warmth and security. It can keep the baby from being disturbed by her startle reflex, and it can help her stay warm and toasty for the first few days of life until her internal thermostat kicks in. It may even help to calm the baby.</p><p><strong>Positioning: </strong>Preterm infants characteristically demonstrate low postural tone, with the amount of hypotonia varying with gestational age. Developmentally supportive positioning for infants in NICU may help to reinforce normal skeletal alignment and provide opportunities for normal movement patterns. In addition, positioning can provide skin care and support respiratory function. The combination of these three benefits can allow the infant to improve and longer sleep.</p><p>Research indicates that infants with long stays in NICU, who are not appropriately positioned, are at risk for positional plagiocephaly, and torticollis and may demonstrate a decrease in the quality and spontaneity of movement. The goal of neonatal positioning is to Optimize alignment toward a neutral neck-trunk position semiflexed, midline extremity posture, and neutral foot position. Hyperextension of the neck, Frequent head turning to the side, Lower extremity frogging, and use of Bigger diapers should be avoided.</p><div class='text-center mb-3 d-flex justify-content-center volOneIssueThreeImg'><img src='/assets/img/image-1(A).jpg' /><img src='/assets/img/image-1(B).jpg' /></div><p>Kangaroo Mother Care: It is a Special way of caring for preterm-low birth weight babies which is practiced in many cultures. It fosters their health and well-being by promoting physiologic stability, breastfeeding, infection prevention, and increased maternal confidence & bonding. Kangaroo care is also known as skin-to-skin contact and the baby is breastfed exclusively to the utmost extent. Direct contact is established by removing all the baby's clothes, except for their diaper, and lying them in a prone position on the mother's chest (the Baby’s abdomen should be at the level of the mother’s epigastria) (Fig-2). It has been found that kangaroo care can be neuroprotective as it supports brain plasticity. KMC can be started as soon as the baby is stable in the hospital and continued at home. Short KMC sessions can be initiated during recovery with ongoing medical treatment (IV fluids, oxygen therapy). During KMC, Mother’s breathing stimulates the baby’s breathing, thus reducing the occurrence of apnea. It also helps decrease maternal stress and depression.</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-2.png' /></div><p><strong>Therapeutic Massage:</strong> Infant massage (i.e. gentle and slow hand contact) is an early intervention approach to help with a newborn's tactile sense. There is some evidence to suggest that massage can help with growth and weight gain for low birth weight and premature babies, reduce the length of stay in the hospital, reduce neonatal stress, and promote sleep.</p><p>Massage therapy with moderate pressure may be useful. Research by Lu et al. has found that moderate- pressure massage therapy can cause greater daily weight gain in preterm infants than light- pressure massage therapy(Fig-3).</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-3.png' /></div><p><strong>Therapeutic Handling:</strong> The primary aims of handling include assisting the newborn to achieve maximal interaction with parents & caregivers, and facilitating postural & movement patterns appropriate to the infant’s adjusted gestational age. It includes care of a neonate around sleep/wake cycles time, no routine procedure, Providing 2-3 hrs of uninterrupted sleep, following “Minimal Handling” or “Quiet hour” Protocol, reducing noise, Reduce lights, and Clustering the caregiving procedure. Don’t disturb the baby all the time.</p><p><strong>Physical Activity:</strong> It has been proposed that a lack of physical stimulation might contribute to metabolic bone disease in preterm infants, leading to decreased bone mineralization and growth. Therefore, physical activity has been explored as an intervention to help promote bone mineralization and growth. Physical activity for neonates includes facilitating extension and flexion of the extremities, performing a range of motion exercises, and holding patients into flexion to help facilitate pushing against resistance. These exercises are usually completed for several minutes, several times a week for at least two weeks. Doğan et al. note that passive range of motion exercises may be beneficial for bone development, especially when applied to an infant's proximal joints.</p><p><strong>Multimodal stimulation:</strong> The use of tactile, vestibular, proprioceptive, visual & auditory stimuli to facilitate infant development has been reported. For auditory stimuli, Soft & soothing music is used. For the tactile stimulus Gentle touch, massage & swaddling, For Visual stimulus pictures/human faces, and bright toys are used. For the Vestibular stimulus gentle rocking movements, and swinging are beneficial.</p><p><strong>Non-Nutritive Sucking:</strong> High-priority functional activities in the NICU are sucking and swallowing. These actions should be supported by the physiotherapist and other caregivers. Non-nutritive sucking provides tactile stimulation to the intraoral structures and facial muscles through a pacifier or a glove-wearing finger (Fig-4). Research shows that non-nutritive sucking can help reduce the length of hospital stay and improve feeding behaviours. It can be done using pacifiers.</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-4.jpg' /></div><p><strong>Family Education:</strong> Family education is a substantial component of interventional care in the NICU. Understanding how to care for the preterm infant is important for posture and movement development, parent-infant attachment, and maintaining the baby's physiological stability. Coaching the family on how to best support the baby's motor development should include topics such as feeding, dressing, sleep positioning, playing and communicating, therapeutic holding, and carrying the newborn after discharge.</p><h4 class='mt-4'>OUR LIFE IN NICU: STORY OF A NICU GRADUATE</h4><hr class='mt-0' /><p>Hello, I am a ‘NICU graduate child’ means after birth I lived in the NICU for some days. My mother said that I was born 8 weeks earlier than the expected date of delivery, so everyone used to call me ‘preemie’. In NICU I made many friends. I heard that some of my friends were like me born premature and others had weak lungs (Respiratory distress syndrome), heart infections (Necrotizing endocarditis), brain tissue infections (Meningitis/Encephalitis), bleeding in the brain (Intraventricular hemorrhage), etc. But all were very strong fighters just like me. The room of the NICU was so strenuous and loaded heavily with noxious stimuli that we couldn’t handle it. The loud noise of machines, the flashing lights, frequent running of doctors and nurses used to frighten me. I was put on oxygen therapy by ‘O2 hood’, and the Nasogastric tube was inserted inside my nose for feeding, and for regulation of my body temperature I used to sleep under a Radiant heat warmer. Besides all these displeasures, I was under constant observation and great care by my neonatologist, physiotherapist, nursing staff, and many more people who always work with enthusiasm. For my weaker lungs, Dr. Neonatologist gave me SURFACTANT THERAPY that made my lungs stronger and helped me breathe efficiently. My Physiotherapist used to SWADDLE me to calm me down and help me regulate my body, giving me different POSITIONINGand NESTING, she used to do MASSAGE THERAPY to strengthen my muscles and CHEST PHYSIOTHERAPY to clear secretions from my lungs. She also taught me NON-NUTRITIVE SUCKING so that later on I can do breastfeeding nicely. My therapist also taught my mother to give KANGAROO MOTHER CARE (skin-to-skin contact) which had increased ‘Mother- Infant bonding’ between us. Gradually I started improving and gaining weight so they sent me home with my family!!</p><p>After living so long in my mother’s womb which is the calmest and safest place, suddenly coming to NICU was quite scary for me so used to cry, cry, and cry....But after realizing that how much care and help they are giving me I wanted to THANK them but I have no words to describe so again I started crying, crying, and crying......!!!</p>

<p>Impact of Physiotherapy in Head and Neck Cancer Head and neck cancer is broadly recognized as the seventh most frequently occurring type of cancer and consists of a various array of tumors affecting the upper aerodigestive tract. Despite the presence of various histologies, squamous cell carcinoma remains the most prevalent. Predominant risk factors include tobacco use, alcohol abuse, and oncogenic viruses, including human papillomavirus and Epstein-Barr virus. Head and neck cancer, comprising a range of malignancies affecting the oral cavity, pharynx, larynx, and surrounding structures, presents complex challenges in both treatment and rehabilitation.[1]</p><p>Physiotherapy plays a crucial role in the management of Oral, Head, and Neck cancer especially during and after Treatment. Here’s how physiotherapy can help [2]</p><div><ol><li><p>Restoration of Function and Mobility: Physiotherapy assists in restoring function and mobility to areas affected by surgery, radiation therapy, or chemotherapy. Therapists develop personalized exercise programs to improve strength, flexibility, and range of motion in the jaw, head, and neck.</p></li><li><p>Swallowing and Speech Therapy: Speech-language pathologists, often working closely with physiotherapists, help patients regain the ability to swallow and speak properly after treatment. This may involve exercises to strengthen swallowing muscles and techniques to improve speech clarity.</p></li><li><p>Pain Management: Physiotherapists use various techniques such as manual therapy, therapeutic exercises, and modalities like heat and cold therapy to manage pain and discomfort associated with cancer treatment.</p></li><li><p>Education and Support: Physiotherapists educate patients about self-care techniques, posture correction, and energy conservation strategies to optimize recovery and enhance the quality of life during and after cancer treatment. Overall, physiotherapy plays a vital role in addressing physical impairments, improving function, and promoting overall well-being in individuals undergoing treatment for oral, head, and neck cancer.</p></li></ol></div><p>TheraBite Jaw Motion Rehabilitation System: Enhancing Jaw Mobility in Head and Neck Cancer Rehabilitation TheraBite is a jaw motion rehabilitation system designed to improve jaw function, range of motion, and reduce trismus (limited mouth opening) often experienced by head and neck cancer patients. The device consists of a hand-held controller and custom-fit mouthpieces, allowing patients to perform exercises that gently stretch and mobilize the jaw muscles and temporomandibular joint (TMJ). Here's how TheraBite is typically utilized in the rehabilitation of head and neck cancer patients:</p><div><ol><li><p>Trismus Management: After surgical procedures or radiation therapy, patients may experience trismus due to scarring, fibrosis, or muscle stiffness. TheraBite helps gradually stretch the muscles and tissues, promoting increased mouth opening over time.</p></li><li><p>Improving Jaw Mobility: TheraBite exercises involve controlled, repetitive movements of the jaw, encouraging improved mobility and flexibility. Patients work with their physiotherapists or speech therapists to establish a customized exercise regimen based on their specific needs and limitations.</p></li><li><p>Pain Management: Jaw exercises with TheraBite can also help alleviate discomfort or pain associated with muscle tightness and restricted movement. The device allows patients to perform exercises at their own pace, adjusting the intensity as tolerated.</p></li><li><p>Functional Restoration: By promoting increased jaw mobility and mouth opening, TheraBite contributes to the restoration of essential functions such as chewing, swallowing, and speech. This is particularly beneficial for patients aiming to regain oral function and quality of life post-treatment.</p></li><li><p>Patient Education and Support: Physiotherapists play a crucial role in guiding patients in the safe and effective use of TheraBite, ensuring proper technique and monitoring progress. They also provide education on self-care strategies and offer support throughout the rehabilitation process.</p></li></ol></div><p>TheraBite is a valuable adjunctive tool in the comprehensive rehabilitation of head and neck cancer patients, facilitating improved jaw function, reduced trismus, and enhanced quality of life. Its integration into personalized treatment plans underscores the multidisciplinary approach required to address the diverse challenges faced by individuals undergoing treatment for head and neck cancer [3].</p><h4 class='mt-4'>References:</h4><hr class='mt-0' /><div class='history'><ol><li><p>Li T, Lu J, Yin Y, Qiu Q. Prognosis prediction and risk stratification in head and neck cancer. Frontiers in Oncology. 2022 Dec 30;12:1037001.</p></li><li><p>Pauli N, Andréll P, Johansson M, Fagerberg‐Mohlin B, Finizia C. Treating trismus: a prospective study on effect and compliance to jaw exercise therapy in head and neck cancer. Head & neck. 2015 Dec;37(12):1738-44.</p></li><li><p>Wu H, Zhou Z, Zhang C, Shen S, Liu J, Zhang C. The progress of post-treatment restricted mouth opening in oral and maxillofacial malignant tumor patients. Frontiers of Oral and Maxillofacial Medicine. 2021 Mar 30;3.</p></li></ol></div>

<p>The ability to engage with others is known as communication. In the realm of physiotherapy, through patient interaction, one can learn about the difficulties patients are having performing specific tasks. Also, a therapist is able to comprehend the psychological context of the patient and the extent of their disturbance. Additionally, the therapist can vocally encourage and build the patient's confidence. Effective communication is essential in physical therapy as it promotes trust, guarantees precise diagnosis, and streamlines treatment regimens.</p><p>Effective communication between the therapist and patients facilitates comprehension of exercises, methods, and goals of rehabilitation, hence improving patient compliance and results. Moreover, proficient communication fosters cooperation among medical experts, culminating in comprehensive patient care and enhanced general health.</p><p>Asking questions, confronting people, focussing, and verbally tracking are all forms of communication in physical therapy. Understanding when to employ each form is crucial for therapists. Therefore, it is not advisable to employ such a confrontation until a therapeutic relationship based on trust has been created.</p><p>Physiotherapists have to work with a specific patient for a minimum of six months and a maximum of one year. Thus, the therapist must use simple language that the patient can comprehend. Furthermore, the therapist will win over the trust of the patient—that is, the person with illnesses or injuries. They will bolster their confidence and inspire them. With the goal for the patient to make more of an effort and heal as quickly as feasible.</p><p>Core of the healthcare industry is communication. Establishing trust, verifying correct diagnosis, treatment plans, and patient compliance all depend on effective communication. Physiotherapists may establish a positive, upbeat environment that will inspire their patients by listening, empathizing, and giving thorough explanations. This will help them develop trust and rapport with their patients. Patients will feel more confident and motivated to achieve their goals as a result of this trust, which will also enable a more thorough grasp of their situation.</p><p>Physiotherapists can discover patients' problems by gathering important information by listening to patients describe their symptoms. With the assistance of a communication therapist, an accurate diagnosis and thorough assessment can be made. Nonverbal cues like body language can also be used in effective communication. Effective communication, education, and empowerment will enable patients to take an active role in their own rehabilitation by giving them the information and comprehension they need. Physiotherapists explain exercises using simple language, essential tools, and hands-on practice. This allows the patient to exercise correctly.</p><p>The therapist will encourage patients to promote exercises and lifestyle modifications by providing clear explanations, creating achievable goals, and providing support in order to ensure patient compliance through communication. Frequent communication also makes it possible to track development and make any required adjustments to treatment programs. The patient's psychosocial needs can be met by the therapist through interaction. A holistic approach is used by physiotherapists to address patients' physical, emotional, and social welfare as well as the psychosocial aspects of their experience, which include feelings like anxiety and fear.</p><p>By providing a secure environment for patients to communicate their worries and feelings, therapists help patients build confidence and trust. Furthermore, communication makes interdisciplinary collaboration easier, enabling therapists to work with other medical providers to meet patients' needs. To sum up, excellent communication is essential for physiotherapists to provide patients with quality therapy. The patient's life will eventually be improved by psychosocial education that promotes understanding, participation, and empowerment from the initial assessment through treatment planning.</p><p>Physiotherapists that possess great communication skills can form strong bonds with their patients, fostering physical rehabilitation and recovery to expedite the healing process.</p>

<h4>ABSTRACT:</h4><hr class='mt-0' /><p><strong>TITLE: </strong>“To find out effect of goldfish exercise in tobacco chewing person for temporomandibular joint dysfunction: an interventional study”</p><p><strong>OBJECTIVE: </strong>To find out the effect of goldfish exercise on pain in tobacco chewers. To find out the effect of goldfish exercise to increase ROM in tobacco chewers. To find out the effect of goldfish exercise on mouth opening in tobacco chewers.</p><p><strong>MATERIAL AND METHODOLOGY: </strong>Total 60 participant were selected after screening with inclusion and exclusion criteria. To collect data, the researchers used a standardized, temporomandibular joint disability index, VAS and mouth opening measurement. The questionnaire was distributed among the tobacco chewers, and they were asked to fill it out honestly and without any external influence. Once the data was collected, it was analysed using statistical methods to determine find out effect of goldfish exercise in tobacco chewing person for the temporomandibular joint dysfunction. The findings of the study were provided important insights of the effect of goldfish exercise in tobacco chewing person for temporomandibular joint dysfunction.</p><p><strong>RESULTS: </strong>Data were analyzing SPSS version 25.0. result of study showed that significant improvement shows is group A. pre &post significant difference (<0.05) P value between group A and B. Conclusion: After analyzing the data which were collected from in and around Amreli. It was found that maximum number of tobacco chewing person suffering from TMD dysfunction, VAS, MOUTH OPENING. This study shown that in, the group-A given the goldfish exercise technique was better and effective then group-B(control group).</p><p><strong>KEY WORDS: </strong>Goldfish exercise, Mouth opening, pain, Temporomandibular dysfunction, tobacco chewer</p><h4 class='mt-4'>INTRODUCTION:</h4><hr class='mt-0' /><p>The temporomandibular joint (TMJ) are located just anterior to the external auditory meatus. The TMJ is a synovial, condylar, modified ovoid, and hinge type joint with fibrocartilaginous surfaces rather than hyaline cartilage and an articular disc. Gliding, translation, or sliding movements occurs in the upper cavity of the temporomandibular joint, whereas rotation or hinge movement occurs in the lower cavity. The capsule of the temporomandibular joint is thin and loose. In the resting position, the is slightly open, lips are together, and the teeth are not in contact but slightly apart. In the closed packed position, the teeth are tightly clenched, and the head of the condyles are in the posterior aspect of the joint. Centric occlusion is the relation of the jaw and teeth when there is maximum contact of the teeth, and it is the position assumed by the jaw in the swallowing. The position in which the teeth are fully integrated is called the median occlusal position. The temporomandibular joints are two of the most frequently used joints in the body, but probably receive the least attention. It has been shown that temporomandibular disorders affect 10% to 15% of adults. Without these joints, one would be severely hindered when talking, eating, yawning, kissing, or sucking. Temporomandibular disorders consist of several complex of multifactorial ailments involving many interrelating factors, including psychosocial issues. Oral lesions (herpes zoster, herpes simplex, oral ulcer), muscle overuse (clenching, bruxism), trauma, systemic lupus erythematosus, rheumatoid arthritis, headaches, and cancer pain can mimic temporomandibular joint disorders. Three cardinal features of temporomandibular joint disorders are orofacial pain, restricted jaw motion, and joint noise.(1)</p><p>The diagnosis of the temporomandibular joint dysfunction will be interpreted by the noise is assessed by the sound heard in stethoscope. A grafting sound indicates perforation of disk or arthritic changes. Limited opening suddenly resolved after click indicates disk displacement with reduction. Reducted ROM without clicking may be suggestive of disk displacement without reduction. The signs and symptoms of TMD disorders are pain and tenderness around jaw, Pain in one or both of the TMJs, pain in and around ear, difficulty in chewing or pain while chewing, locking of joint. Making it difficult to open or close the mouth, headache, neck pain, mental depression. The areas where pain of TMJ can radiate are temporalis, masseter, trapezius, sternoclenomastoid. (2) Goldfish Exercise was developed by Japanese Health Care Practitioner-SEIGO NISHI.</p><p>This exercise was an outcome of inspiration on the concept of elegant swimming motion of the Goldfish. When this concept was put into practice, the Japanese realized its benefits at many levels. This newly found way of exercising became known in Japan as “KINGYO UNDO” or “GOLDFISH EXERCISE”. The pain assessment in systematically is essential for correct diagnosis. This pain is a subjective part for both patient and health care professionals. So, require a valid and reliable tool for measurement of pain. VAS is widely used as a measure of pain intensity in globally. It has been shown that VAS is valid, reliable and interval scale. VAS has high test-retest reliability and repeatability. VAS is used in epidemiological and clinical research to measure the intensity or frequency of a variety of clinical symptoms. In randomized controlled trials, clinical trials VAS is frequently used to determine the effectiveness of treatment as an outcome measure.</p><p>Recently, there are different type of scale are used for assessing pain but without any valid (accurate) and reliable (reproducible) instruments it is very difficult to find real effect of treatment. The intensity of pain is a quantitative estimation and the most commonly used pain scales are the Visual Analogue Scale (VAS), the Numerical Rating Scale (NRS) the Verbal Rating Scale (VRS). (3) The mouth opening is an important indication of the functionality of the temporomandibular joint. A limitation in the degree of opening can be symptom of TMJ dysfunction. It is usually defined as the distance between the incisor crests when the mouth is open maximum, or as the interincisal distance plus the overbite. The mouth opening is usually measured simply by asking the patient to their mouth open as wide as possible and measuring the distance between the edges of the frontal incisors with a ruler or calliper, and in some cases, the overlapping of the incisors is added.</p><p>All these methods have in common that the measurements is usually taken manually and are dependent on the experience of the professional taking them.(4) Temporomandibular joint disability index assesses pain and routine functional skills requiring oral functions. It has 10 sections of pain and disability during various activity. The patient was asked to circle the number which describes his problem best. Total scores out of 40 was calculated and converted into percentage. (5)</p><h4 class='mt-4'>Methodology:</h4><hr class='mt-0' /><p>The samples were be selected from the population on the of inclusion and exclusion criteria. Prior to the study, all patients were explained about the procedure, written informed consent was taken. Pre-participation evaluation form consisted of the demographic data of the patient that includes age, chief complain, history, previous surgery, pain assessment, range of motion. 60 patients having TMJ dysfunction was randomly taken from the in and around Amreli. They were randomly divides into two groups and they not know about group allocation. Group1: received goldfish exercise. Group2: control group. For 2 weeks duration, 5 times/week & No. of patients in each group = 30. The patients were requested to continue normal activities and avoid other forms of treatment for 2 weeks apart from routine physician treatment. Visual Analogue Scale (VAS), Mouth Opening (MO) and Temporomandibular Joint (TMJ) Disability Index were taken Pre and Post treatment.</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-5.png' /></div><h4 class='mt-4'>Result:</h4><hr class='mt-0' /><p>Data were analysing SPSS version 25.0. with using pair and unpaired t test. result of study showed that significant improvement <0.05 P value shows is group A. pre &post significant difference (<0.05) P value between group A and B.</p><div><table class='table table-responsive table-hover'><caption>Table 1: - Describes the improvement in the TMD dys0function in the group A</caption><thead><tr><th></th><th colspan='2'>Mean ± SD</th><th></th><th></th><th></th></tr></thead><tbody><tr><td></td><td>Pre</td><td>Post</td><td>T</td><td>P</td><td>Result</td></tr><tr><td>TMD</td><td>11.6±6.7</td><td>4.6±3.2</td><td>9.17</td><td>0.00</td><td>Significant</td></tr><tr><td>VAS</td><td>6.5±0.9</td><td>4.61±1.1</td><td>9.06</td><td>0.00</td><td>Significant</td></tr><tr><td>MOUTH OPENING</td><td>2.25±0.5</td><td>3.3±0.5</td><td>-7.79</td><td>0.00</td><td>Significant</td></tr></tbody></table> <table class='mt-4 table table-responsive table-hover'><caption>Table 2:- Describes the improvement in the TMD dysfunction in the group B</caption><thead><tr><th></th><th colspan='2'>Mean ± SD</th><th></th><th></th><th></th></tr></thead><tbody><tr><td></td><td>Pre</td><td>Post</td><td>T</td><td>P</td><td>Result</td></tr><tr><td>TMD</td><td>11.1±6.15</td><td>10.9±5.9</td><td>1.98</td><td>0.06</td><td>Not-Significant</td></tr><tr><td>VAS</td><td>6.12±1.1</td><td>6.2±1.01</td><td>-4.38</td><td>0.05</td><td>Not-Significant</td></tr><tr><td>MOUTH OPENING</td><td>3.05±0.4</td><td>2.9±0.4</td><td>2.63</td><td>0.13</td><td>Not-Significant</td></tr></tbody></table></div><div class='text-center mb-3'><img src='/assets/img/image-6.png' /></div><h4 class='mt-4'>Discussion:</h4><hr src='mt-0' /><p>The aim of the study to find out the effect of goldfish exercise in tobacco chewing person for temporomandibular joint dysfunction. The study utilized a interventional design, and data were collected in and around Amreli. the study included 60 tobacco chewing person. And divided into two groups. Group A recived goldfish exercise and group B was control group. The result of the study revealed significant differences exists between two groups they received the goldfish exercise and control group. Hence, the alternate hypothesis stating that there is significant differences between goldfish exercise and control group on tobacco chewing person can be accepted and the null hypothesis can be rejected. Subjects who recived goldfish exercise showed improvement with the outcome measure. Subjects who are in control group didn’t showed improvement with the outcome measure. But on comparing both the group. Group A seems more effective. The outcome measure will be used are used are VAS scale, TMJ disability index and increase in mouth opening. While the control group showed no statistical reduction on pain, TMJ disability index, mouth opening measurement. Goldfish exercise works on the principle of pulsatile motion of goldfish in water & thereby imitating the same motion for health benefits. It can be thought of stretching the fibrous bands, reducing TMJ stiffness & resulting in improvement in mouth opening. It would be beneficial to use this technique on daily basis and as far there are no contraindications of this exercise because it`s done with in pain limits& further progression depends on the mouth opening of the patient. Goldfish exercise can be given to the patients having jaw problems and even taught for home exercise program. However, there was a significant result was noticed in the Group A i.e. goldfish exercise, when t-test is performed to find out the effect.</p><h4 class='mt-4'>Conclusion:</h4><hr class='mt-0' /><p>After collecting and analyzing the data which collected from in and around Amreli. It was found that maximum number of tobacco chewing person suffering from temporomandibular joint dysfunction. This study shown that in, the group A given the goldfish exercise technique was better and effective in temporomandibular joint dysfunction then group B (control group)</p><h4 class='mt-4'>References:</h4><hr class='mt-0' /><div class='history'><ol><li><p>DAVID J. MAGEE, ROBERT C.MANSKE. orthopaedic physical assessment seventh edition page no :(243)</p></li><li><p>MEGHA S.SHETH, PRIYA SING RANGEY. Physiotherapy in orthopedic and rheumatologic conditions page no:(446-447)</p></li><li><p>Setoo jain, yagna umesh Shukla: EFFECT OF GOLDFISH EXERCISE ON PAIN,MOUTH OPENING,AND TEMPOROMANDIBULAR JOINT DISABILITY IN ORAL SUBMUCOUS FIBROSIS -A RANDOMIZED CONTROL TRIAL. January 2017</p></li><li><p>Franco Marinelli, maria florenica lezcano, Josefa Alarcon: A NOVEL TECHNIQUE TO ACCURATELY MEASURE MOUTH OPENING USING 3D ELECTROMAGNETIC ARTICULOGRAPHY. October 2022.</p></li><li><p>Azizfatema munawer khan, megha s. sheth, romsa r. purohit: Effect of areca nut chewing and maximal mouth opening in schoolgoing children in Ahmedabad. December 2016</p></li><li><p>Toby n. Weingarten,barton c. Iverson, Kevin I. Reid “Impact of tobacco use on the symptoms of painful temporomandibular joint disorder” at 2019.</p></li><li><p>Mst. Rabea Begum1 *, Mohammad Anwar Hossain “VALIDITY AND RELIABILITY OF VISUAL ANALOGUE SCALE (VAS) FOR PAIN MEASUREMENT” at 2019.</p></li></ol></div>

Volume-1, Issue-3

<h4>What is Sports Nutrition?</h4><hr class='mt-0' /><p>It can be defined as the application of nutrition knowledge to a practical daily eating plan focused on providing the fuel for physical activity, facilitating the repair and rebuilding process following hard physical work, and optimizing athletic performance in competitive events, while also promoting overall health and wellness.</p><div class='text-center'><img src='/assets/img/vol1_issue4_img1.png' alt='volume 1 - issue 4' class='img-fluid' /><p>The Nutrient Trio: Carbs, Proteins, Fats – A Dietary Dance</p></div><p>Carbohydrates, proteins, fats, vitamins, minerals, and water are recognized as essential nutrients. Within the body, carbohydrates are metabolized into glucose, serving as the primary energy source for all forms of physical exertion. These nutrients are abundant in a diverse range of foods, encompassing grains, fruits, vegetables, as well as various milk substitutes such as soy, rice, and nut-based beverages. Proteins, composed of amino acids, play a crucial role in the development, growth, and repair of muscles and other bodily tissues, making them vital for recovery following intense physical exercise. While proteins are present in many foods including grains and vegetables, they are predominantly found in dairy and dairy alternatives, along with meat and plant-based protein sources such as soy products, nuts, seeds, and legumes. Pre-workout meals should be high in carbohydrates and moderate in protein to provide energy and support muscle function. Post-workout meals should include protein to aid in muscle recovery and repair.</p><p>Fats, also referred to as lipids, are derived from both plant and animal sources in our diet. Triglycerides represent the most prevalent form of fat. Other types include cholesterol and phospholipids. Fats play a vital role in providing structural integrity to cell membranes, supporting hormone production, forming the insulating sheath around nerve cells, and aiding in the absorption of fat-soluble vitamins. Fat primarily serves as an energy source during periods of rest and during low- to moderate-intensity physical activities. Chronic inflammation can lead to tissue damage and elevate the risk of injuries. Consuming certain foods, particularly those high in omega-3 fatty acids (such as fatty fish, flaxseeds, and walnuts) and antioxidants (such as fruits, vegetables, and nuts), can help mitigate inflammation due to their anti-inflammatory properties.</p><h4>The Nutrient Superstars: Exploring the Vital Roles of Vitamins, Minerals, and Water:</h4><hr class='mt-0' /><p>Vitamins play a crucial role in a multitude of bodily functions and processes essential for maintaining health and preventing disease. They are categorized based on their solubility: water-soluble (including B vitamins and vitamin C) and fat-soluble (comprising vitamins A, D, E, and K), which influences their absorption, transportation, and storage within the body. Carbohydrates, fats, and proteins, are also known as energy nutrients, provide the body with energy. This energy is stored in the chemical bonds of these nutrients and released during metabolic processes that break them down into carbon dioxide and water. Some of this released energy is captured to form adenosine triphosphate (ATP), the body's immediate energy source for cellular functions. The remaining energy is dissipated as heat. ATP is essential for muscle contraction and, without it, athletes could not perform physical activities. Vitamins are abundant in the diet, present across nearly all food groups such as fruits, vegetables, grains, meat and plant-based proteins, dairy and its alternatives, as well as certain fats. Collagen, a protein that provides the structural foundation for tendons, ligaments, and other connective tissues, relies on nutrients that support its synthesis. Foods high in collagen-boosting nutrients, like vitamin C found in citrus fruits, bell peppers, and strawberries, are beneficial for maintaining the health and integrity of these tissues, thereby reducing the risk of injuries such as tendonitis and ligament strains.</p><p>Minerals are essential for tissue development and the regulation of bodily processes. Physical activity stresses muscles and bones, increases the demand for oxygen transport in the blood, and results in sweat and electrolyte loss, necessitating sufficient mineral intake and replenishment. Minerals are divided into major minerals such as calcium, sodium, potassium, chloride, phosphorus, magnesium, and sulfur and trace minerals, including iron, zinc, copper, selenium, iodine, fluoride, molybdenum, and manganese. These minerals are predominantly found in meat, beans, and dairy products.</p><p>The body consists of 55–60% water, integral to nearly all tissues and fluids. In sports, water is crucial for regulating temperature, lubricating joints, and transporting nutrients to active tissues. Besides plain water, hydration can be maintained through beverages like juices, milk, coffee, tea, and water-rich foods such as fruits, vegetables, and soups. Dehydration can impair performance and increase the risk of injuries like muscle cramps and heat-related illnesses. Athletes should ensure adequate fluid and electrolyte intake before, during, and after exercise. Additionally, sufficient calcium and vitamin D are vital for bone health, reducing the risk of fractures and stress injuries. Athletes should consume calcium-rich foods, such as dairy products, leafy greensand obtain adequate vitamin D from sunlight and supplements if necessary.</p><div class='text-center'><img src='/assets/img/vol1_issue4_img2.png' alt='volume 1 - issue 4' class='img-fluid' /><p>Food pyramid for balanced diet for 2000 kcal (Image source: ICMR-NIN, Dietary guidelines for Indians)</p></div><h4>Nutritional Navigation: Navigating Dietary Guidelines for Optimal Health:</h4><hr class='mt-0' /><p>The Indian Council of Medical Research (ICMR) has updated its dietary guidelines for Indians, developed by a multidisciplinary committee of experts led by Dr. Hemalatha R, Director of ICMR-NIN. The revised Dietary Guidelines for Indians (DGIs) list seventeen specific recommendations, including consuming a variety of foods for a balanced diet, eating plenty of vegetables and legumes, and sourcing proteins from food items rather than commercial supplements. For a balanced diet of 2000 kcal, the guidelines recommend 500 grams of vegetables and fruits, 250 grams of cereals, along with pulses, legumes, fish or meat, and milk. The National Institute of Nutrition (NIN) in Hyderabad warns that prolonged consumption of large amounts of protein powders or high-protein concentrates can lead to bone mineral loss and kidney damage. The guidelines also recommend that sugar intake should be less than 5% of total energy, with no more than 45% of calories from cereals and millets, and up to 15% from pulses, beans, and meat. The remaining calories should come from nuts, vegetables, fruits, and milk, with total fat intake not exceeding 30% of energy. Insufficient intake of essential nutrients can disrupt metabolism and increase the risk of insulin resistance and related disorders from an early age. The rise in consumption of highly processed foods high in sugars and fats, along with reduced physical activity and limited access to diverse foods, has exacerbated micronutrient deficiencies and obesity. The guidelines emphasize that ultra-processed foods like noodles, breakfast cereals, soup mixes, and cake mixes are unhealthy, even if enriched or fortified with nutrients.</p><p>It is estimated that 56.4% of India's total disease burden is due to unhealthy diets. Adopting healthy diets and physical activity can significantly reduce the risk of coronary heart disease, hypertension, and up to 80% of type 2 diabetes.</p><h4>References:</h4><hr class='mt-0' /><div class='mb-5'><ol><li><p>Practical Applications in Sports Nutrition, Seventh Edition Heather Hedrick Fink, Alan E. Mikesky.</p></li><li><p>Dietary guidelines for Indians. Revised edition 2024.</p></li></ol></div>

<h4>ABSTRACT:</h4><hr class='mt-0' /><p>Purpose: This study determined the effects of a new modality of core stabilisation exercises based on diaphragmatic breathing on abdominal fitness.</p><p>Subjects: 60 physically inactive, healthy males and females were randomly assigned to an experimental group (n = 30) and a control group (n = 30).</p><p>Methods: The experimental group combined diaphragmatic breathing exercises with global stretching postures and common abdominal exercises, and the control group performed only common abdominal exercises both for 20 minutes 4 times weekly for 4 weeks. Abdominal fitness (measured with the American College of Sports Medicine curl-up [cadence] test, Double leg lowering test (DLLT) and Isometric Trunk flexor endurance test (ITFET).</p><p>Results: Significant changes in curl-up (cadence) test, Double leg lowering test and Isometric trunk flexor endurance test were recorded in the experimental group at the post training assessment, whereas in the control group, no significant differences over baseline were observed in Isometric trunk flexor endurance test and ACSM curls up test.</p><p>Conclusion: Compared with traditional abdominal exercises, core stabilisation exercises based on breathing and global stretching postures are more effective in improving abdominal fitness.</p><p>KEYWORDS: Abdominal strength, Abdominal endurance, Diaphragmatic breathing</p><h4 class='mt-5'>INTRODUCTION:</h4><hr class='mt-0' /><p>In recent years, abdominal muscle training has gained increasing popularity, and exercises like “crunches” or “planks” have become an integral part of both fitness and rehabilitation programs. The abdominal muscles are the muscles forming the abdominal walls, the abdomen being the portion of the trunk connecting the thorax and pelvis. An abdominal wall is formed of skin, fascia, and muscle and encases the abdominal cavity and viscera.<br /><br />It consists of four main muscles:</p><div><ol><li><p>Transversus abdominis</p></li><li><p>Rectus abdominis</p></li><li><p>External oblique muscles</p></li><li><p>Internal oblique muscles</p></li></ol></div><p>All the abdominal muscles have different muscle fibres orientation and act in all three planes during movements and are linked together by having a common site of connection or by fascia. Actions associated with abdominal muscle control can be complex. A single muscle does not usually work in isolation but in harmony with others. The abdominal muscles support the trunk, allow movement, hold organs in place, and are distensible (being able accommodate dynamic changes in the volume of abdominal contents).</p><p>The deep abdominal muscles, together with the intrinsic back muscles, make up the core muscles and help keep the body stable and balanced, and protects the spine. The most common traditional exercises) and training methods to enhance abdominal strength and stability employ body weight exercises consisting of static or dynamic contractions in various body positions (e.g., supine, lateral), starting with isolated movements and then continuing through with more complex sequences such as crunches, sit-ups, and planks (prone or lateral).</p><p>Correct breathing (especially as it involves the respiratory muscles) is vital to abdominal training because respiratory muscles are directly involved during common core stability exercises. DePalo et al. found that the diaphragm is actively recruited in many resistant training exercises, including sit-ups. Other studies demonstrated that the respiratory muscles are involved in a variety of activities in which respiration is not primarily involved. Because breathing is one of the most basic patterns directly related to human movement, as seen in neonates, inefficient breathing may result in muscular imbalance and motor control alterations that can affect general motor quality.</p><p>The aim of this study was to evaluate whether, as compared with a training protocol of common exercises, abdominal training plus breathing exercises would more greatly enhance abdominal strength and endurance.</p><h4 class='mt-5'>SUBJECTS AND INCLUSION CRITERIA:</h4><hr class='mt-0' /><p>All participants gave their consent via an online form after having been informed about the objectives and scope, procedures, risks, and benefits of the study. Participation was voluntary, and withdrawal from the study was permitted at any time.<br /><br />Total number of subjects: 60 [Experimental group or group 1 = 30],[Control group or group 2 = 30]</p><div><p><strong>Inclusion criteria:</strong></p><ul><li><p>Nonsmokers without pulmonary disease or a history of low back pain</p></li><li><p>Gender – Female and Male both</p></li><li><p>People willing to participate in the study</p></li></ul><p><strong>Exclusion criteria:</strong></p><ul><li><p>People with history of any recent fracture/pathology or abdominal/spine surgery</p></li><li><p>People involved with a high intensity exercise regime</p></li><li><p>People having frequent episodes on low back pain</p></li><li><p>Acute or chronic smokers</p></li><li><p>Any cardiopulmonary disease</p></li></ul></div><h4 class='mt-5'>PROCEDURE AND TOOLS:</h4><hr class='mt-0' /><p>Before the start of the study, all subjects did not engage in any physical activity. The subjects were matched and randomly assigned to two groups. Each group performed the assigned exercise protocol for 20 minutes, 4 times per week. Data were collected before and after 4 weeks of training. No other physical exercise, aside from that specified for the purposes of this study, was performed during the study period.</p><p>Study design: An experimental study</p><p>Sampling method: Simple random sampling</p><p>Sample size: Total 60</p><p>Group 1 [EG]: 30 individuals, mean age 21 ± 3 years, height 1.65 ± 8 m, weight 57 ± 9 kg (Female:male=15:15)</p><p>Group 2 [CG]: 30individuals, mean age 21 ± 3 years, height 1.61 ± 12 m, weight 51 ± 9 kg (Female:male=15:15)</p><p>Study setting: Government physiotherapy college, Jamnagar.</p><p>Study duration: 4 weeks</p><p>The American College of Sports Medicine (ACSM) curl-up (cadence) test, Double Leg Lowering test (DLLT), and Isometric Trunk Flexor Endurance test (ITFET), were used to assess abdominal muscle fitness.</p><div><ol><li><p><strong>Timed Partial Curl Up Test:</strong></p><p>The timed partial curl up test is a standard in the fitness industry and is included here, even though it uses the hook lying position and thus encourages hip flexor activation.<br /><br />Purpose: Strength test for abdominals.</p><p>Position of Patient: Supine in hook lying position on a mat with arms at sides, palms facing down, and the middle fingers touching a piece of tape affixed to the surface parallel to the hand. A second piece of tape is affixed 12 cm (4.7 in) further than the initial tape for those younger than 45 years and 8 cm (3.1 in) further for those 45 years and older.</p><p>Stand to the side of the patient. Ask the patient to perform a slow, controlled sit up in time, lifting head and scapulae off the mat, while the middle finger reaches to the second tape. If successful, use a metronome set to 40 beats/min to time repetitions. Ask the patient to curl up as many times as possible keeping time with the metronome. The low back should be flattened before curl up. Test: The individual does as many curl ups as possible without pausing, to a maximum of 75.<br /><br />Scoring: ACSM Norms for partial curl up</p><div class='text-center'><img src='/assets/img/vol1_issue4_img3.png' alt='volume 1 - issue 4' class='img-fluid mb-4' /></div></li><li><p><strong>Isometric Trunk Flexor Endurance Test (ITFET):</strong></p><p>Purpose: Measure isometric core endurance.</p><p>Position of Patient: Sitting on table with wedge supporting the back at angle of 60° to the table. Hips and knees flexed to 90°, with feet stabilised with a strap. Arms are folded across the chest. Ask the patient to hold the test position when the wedge is pulled back 10 cm. Time effort as soon as the wedge is pulled back. Terminate test when the patient can no longer maintain the 60° angle independently.<br /><br />Scoring: Ages 18 to 55 years (mean, 30 years), mean hold time = 178 seconds.<br /><br />Exercisers held the test 3 times as long as nonexercisers (186 s vs. 68.25 s)</p></li><li><p><strong>The Double Leg Lowering test (DLLT):</strong></p><p>Purpose: To assess abdominal muscles and the ability of muscles to maintain the posterior pelvic tilting position against the load (lowering both lower limbs from the vertical position)</p><p>Position of Patient: Subject lying in supine, the arms are held across the chest and the head rested on the floor.</p><p>The tester places their finger tips underneath the subject's lower back. The subject may bend their knees first to move to the starting position, before straightening the knee joint. The subject aims to sustain the pressure on the tester's fingers under the lower back by contracting the abdominals as the legs are lowered. During the test, if the pressure on your hand is decreased, stop the test and the angle is measured.<br /><br />The score is the angle of the legs in degrees from the floor. Below is a guide to scoring for this test :</p><table class='table table-responsive table-hover'><thead><tr><th>Angle</th><th>Rating</th></tr></thead><tbody><tr><td>90 degree</td><td>very poor, starting position</td></tr><tr><td>75 degree</td><td>poor</td></tr><tr><td>60 degree</td><td>below average</td></tr><tr><td>45 degree</td><td>average</td></tr><tr><td>30 degree</td><td>above average</td></tr><tr><td>15 degree</td><td>good</td></tr><tr><td>0 degree</td><td>excellent, legs horizontal</td></tr></tbody></table><p>The two training protocols were administered for 20 minutes 4 times per week for 4 weeks in both groups; all exercises were performed after a standardised 10-minute warm-up.</p><p>The EG exercises were focused on achieving and maintaining a proper diaphragmatic breathing pattern for 2–3 seconds during inspiration and 8–10 seconds during expiration, with a vocal sound emitted to induce active deep internal abdominals. To do this, the subject inhales, expanding the lower abdominal region, the side and back of the abdomen, and the lower ribs. The chest is kept relaxed without pushing out the stomach, and the head is aligned with the spine to avoid excessive bending of the spine or body compensations. The exercise sequence is as follows:<br/><br /><strong>EXERCISES FOR EXPERIMENTAL GROUP [EG]:</strong></p><ol><li>GLOBAL MUSCLES STRETCHING POSTURES</li><li>CRUNCHES: 15 repetitions, 2 sets</li><li>CRUNCHES WITH ROTATION: 15 repetitions on both sides, 2 sets</li><li>QUADRUPED-ALTERNATE ARM AND LEG RAISE: 15 second hold, 2 series</li><li>PLANK ON ELBOWS: 15 second hold, 2 series</li></ol><p class='mt-4'><strong>EXERCISES FOR CONTROL GROUP [CG]:</strong></p><ol><li>CRUNCHES: 15 repetitions, 2 sets</li><li>QUADRUPED-ALTERNATE ARM AND LEG RAISE: 15 second hold, 2 series</li></ol><p class='mt-4'>For statistical analysis, data were obtained before the treatment and after the end of treatment from both the groups. Sit and reach test was scored before and after the intervention.</p><p>Mean and standard deviation of Pre and Post-test values of ITFET, DLLT and ACSM Curls up test of Group 1 [EG] and group 2 [CG] was calculated. Data was entered into a personal computer, and all statistical analyses were performed using the Statistical Package for the Social Sciences IBM™ SPSS™ version 25.0. Descriptive statistics such a mean and standard deviation were calculated to describe all the variables. For normal distribution of data, normality test “Shapiro-wilk test” was done.</p></li></ol><p><strong>Normality test:</strong></p><p>If p <0.05 : then the null Ho hypothesis can be rejected (i.e. the variable is not normally distributed).<br />If p > 0.05: then the null H1 hypothesis can be accepted (i.e. the variable is not normally distributed).</p><ol><li><p>Results were tested for normal distribution using a Shapiro-Wilk test.</p><table class='table table-responsive table-hover table-bordered'><thead><tr><th></th><th>Experimental group (EG)</th><th>Control Group (CG)</th></tr></thead><tbody><tr><td>ITFET</td><td>p=0.003 (P<0.05)</td><td>p=0.075 (P>0.05)</td></tr><tr><td>DLLT</td><td>p=0.000 (P<0.05)</td><td>p=0.00 (P<0.05)</td></tr><tr><td>ACSM Curls up test</td><td>p=0.465 (P>0.05)</td><td>p=0.123 (P>0.05)</td></tr></tbody></table><p>In our data for Group 1[EG] the data for ITFET and DLLT is not normally distributed, data for ACSM Curls up test is normally distributed. For Group 2 [CG] the data for IFET and ACSM Curls up test is normally distributed, data for DLLT is not normally distributed.</p></li><li><p>For within group analysis Wilcoxon test and Paired t test respectively.</p><table class='table table-responsive table-hover table-bordered'><caption class='text-center'>Paired t test</caption><thead><tr><th>Group</th><th>Outcome measure</th><th>N</th><th>Mean</th><th>SD</th><th>t Value</th><th>df</th><th>p Value</th></tr></thead><tbody><tr><td>Experimental group</td><td>ACSM Curls up test</td><td>30</td><td>-7.23</td><td>6.41</td><td>-6.17</td><td>29</td><td>0.000</td></tr><tr><td>Control Group</td><td>DLLT</td><td>30</td><td>-14.70</td><td>45.81</td><td>-1.75</td><td>29</td><td>0.089</td></tr><tr><td></td><td>ACSM Curls up test</td><td>1.46</td><td>30</td><td>9.13</td><td>0.879</td><td>29</td><td>0.387</td></tr></tbody></table><table class='table table-responsive table-hover table-bordered'><caption class='text-center'>Wilcoxon test</caption><thead><tr><th>Group</th><th>Outcome measure</th><th>Z</th><th>p Value</th></tr></thead><tbody><tr><td>Experimental group</td><td>ITFET</td><td>-4.78</td><td>0.000</td></tr><tr><td></td><td>DLLT</td><td>-4.58</td><td>0.000</td></tr><tr><td>Control Group</td><td>DLLT</td><td>-2.81</td><td>0.005</td></tr></tbody></table></li><li><p>We compared the outcome of the above analysis using Mann Whitney test and Independent t test respectively.</p><table class='table table-responsive table-hover table-bordered'><caption class='text-center'>Mann Whitney test</caption><thead><tr><th>Outcome measure</th><th>Mann-Whitney U diff</th><th>Wilcoxon W diff</th><th>Z diff</th><th>p Value diff</th></tr></thead><tbody><tr><td>ITFET</td><td>266.5</td><td>731.5</td><td>-2.713</td><td>0.007</td></tr><tr><td>ACSM Curls up test</td><td>392.5</td><td>857.5</td><td>-0.852</td><td>0.394</td></tr></tbody></table><table class='table table-responsive table-hover table-bordered mt-3'><caption class='text-center'>Independent t test</caption><thead><tr><th>Outcome measure</th><th>N</th><th>Mean diff</th><th>Std. Error Difference</th><th>t Value</th><th>df</th><th>p Value</th></tr></thead><tbody><tr><td>DLLT</td><td>30</td><td>-8.83</td><td>2.82</td><td>-3.12</td><td>58</td><td>0.003</td></tr></tbody></table></li></ol><p class='mt-4'><strong>RESULTS:</strong><br /><br />The above analysis suggests -</p><ul><li><p>Comparison of the pre and post intervention values (Wilcoxon signed rank test and Paired t test) of the outcome measure showed there was statistically significant difference in all test values in the Experimental group. For the control group significant difference is only seen in the ACSM Curls up test.</p></li><li><p>On comparing both group values (Mann Whitney test and Independent test) showed that there was no statistical difference between the two groups in terms of ACSM Curls up test, but there is statistical difference seen in ITFET and DLLT.</li></ul><p><strong>DISCUSSION:</strong></p><p>The main finding of this study is that, compared with traditional exercises, a program including core exercises performed with a focus on muscular chain stretching and breathing techniques can lead to greater improvement in abdominal muscle endurance and muscle strength to some extent. Furthermore, the results suggest that a series of exercises performed with a vocal sound emission can be a valid strategy to enhance proper diaphragmatic breathing patterns and deep internal abdominal activation much more than in traditional abdominal routines in which people tend to hold their breath or use chest wall respiration.</p><p>Our results show that, while traditional core exercises can improve muscular strength and endurance, improvements are greater with muscular chain stretching in combination with breathing techniques.</p><p>As reported in previous studies, proper diaphragmatic breathing is directly linked to better functional movement, but combining proper breathing with global stretching postures can produce a greater effect. Regarding the biomechanical aspects of breathing, the expiration phase promotes active recruitment of the abdominal muscles, contrasting the natural elevation of the rib cage (induced by raising the arms overhead); to the contrary, elevating the arms raises the anterior chest wall, makes the thoracolumbar column hyperlordotic, and puts the diaphragm in an oblique position that inhibits its proper function. During exhalation, the thoracolumbar spine returns to a more neutral position (opposing the previous hyperlordosis), and the diaphragm is more horizontal without posterior pelvic tilt. The subject should inhale to expand the lower portion of the abdominal region, the side and back parts of the abdomen and lower ribs, keeping the spine aligned and the chest relaxed. Using a correct diaphragmatic breathing pattern promotes co-contraction of the abdominal muscles in the so-called bracing technique, which provides trunk stiffness and stability.</p><p>When focusing on diaphragmatic breathing, it is important not only to reestablish a correct respiratory pattern but also to ensure lumbar spine stabilisation by increasing intra-abdominal pressure and activation of the core structures to transfer forces from the centre of the body to the lower extremities. To produce an economic breathing pattern, all joints must be centred in a stable position to involve all muscular chains. The head, eyes, and spinal curves should all be aligned with the pelvis and the hips down to the knees and feet. This can be achieved with proper diaphragmatic breathing and adequate muscle tone distribution (as can be trained with EG exercises).</p><p><strong>LIMITATIONS:</strong></p><p>The present study has several limitations. The sample size was small, and the subjects did not belong to a specific population. Electromyographic assessment of the abdominal muscles was not performed. In addition, the control group exercise protocol was home based, the experimental group performed the exercises under observation.</p></div><p><strong>CONCLUSION:</strong><br /><br />In conclusion, EG exercises that incorporate correct breathing patterns and body flexibility offer an alternative to traditional abdominal exercises. As such, they may be useful for coaches or physical therapists when selecting core exercises to improve overall abdominal fitness and to retrain correct diaphragmatic breathing. Further research is needed to compare abdominal breathing with other core exercises in order to clarify the combination of breath and abdominal exercises in treating painful disorders (low back pain, neck pain) and improving motor control in fitness and rehabilitation programs which was not possible for this research due to limited time limit.</p>

<p>Geriatric rehabilitation involves a collaborative procedure between a medical professional and patients with the goal of preserving or regaining optimal function in multiple domains of life. New methods for assisting geriatric rehabilitation are provided by Internet of Things (IoT)-based technologies. Such technologies may facilitate easy and real-time data communication between healthcare providers to support the delivery of care, in addition to providing tools for measuring and monitoring health issues. The elderly population may benefit significantly from Internet of Things (IoT) technologies that guarantee efficient and equitable rehabilitation. Example of IoT are Bio stamp and Ambient sensor devices.</p><h4 class='mt-4'>BIO STAMP:</h4><hr class='mt-0' /><p>Bio stamp is a thinner than a Band-Aid. The sensors monitor temperature, movements, heart rate, and all these vital signs which are be transmitted wirelessly to an application. The micro-controller efficiently processes signals from the 3-axis accelerometer and gyroscope, sampling the sensor data for storage in flash memory or wireless transmission via Bluetooth. Users can establish wireless Bio Stamp device's operating parameters such as sampling rate, measurement type and measurement range prior to data collection by using a customized mobile application. Additionally, this intelligent mobile device makes it easier for data from the Bio stamp sensors to be transferred to a cloud server for further evaluation. The Bio Stamp might upload its data to a nearby smartphone for analysis through near field communication (NFC), a wireless technology that allows devices to communicate data. Ideally, the patch can be linked with a thin-film battery from a commercial provider, or a phone with an NFC chip can be waved over the patch to enable continuous data transmission between the patient and the clinician.</p><h4 class='mt-4'>Uses of this device :</h4><hr class='mt-0' /><div><ul><li><p>Health Monitoring: By continuously tracking vital signs like body temperature, heart rate, and hydration levels, these gadgets can aid in the early detection of health problems.</p></li><li><p>Fall detection: By integrating accelerometers and gyroscopes, bio stamps can identify falls a typical risk for the elderly and send immediately signals for prompt assistance.</p></li><li><p>Medication Management: They can help patients in line to treatment plans by keeping track of drug levels in the body and reminding them when to take their medication as prescribed.</p></li><li><p>Chronic Disease Management: Bio stamps can give medical professionals access to real-time data on ailments like COPD, diabetes, or hypertension, facilitating better management of chronic illnesses.</p></li><li><p>Comfort and Convenience: Bio stamps are lightweight, non-invasive, and do not limit movement, which makes them more comfortable for senior users than typical monitoring systems, which can be heavy or painful.</p></li><li><p>Remote Healthcare: Bio stamps can provide data to medical practitioners via the internet negating the need for recurrent hospital visits as telemedicine becomes more common.</p></li></ul><p>This advanced technology guarantees ongoing monitoring of health in a convenient and discrete manner which may significantly enhance their quality of life for elderly patients.</p></div><div class='mt-4'><h4>AMBIENT (IN-HOME) SENSORS:</h4><hr class='mt-0' /><p>In the past, a concept known as 'ambient intelligence' has served as the basis for the research and development of a variety of assistive technologies. This paradigm aims to empower individuals by creating digital environments that are perceptive, flexible, and human-centered. Ambient aided technologies are those that utilize ambient intelligence to support assisted living. Ambient or in-home sensors may provide important information on the context and interactions of a person with their surroundings. A variety of environmental characteristics, including motion, light, temperature, pressure, and humidity, can be monitored with the use of ambient sensors. A range of sensors found in homes, including pressure sensors, webcams, and accelerometer can be used to identify anomalies such as falls and abrupt changes in activity. Additional uses for ambient house sensors include social isolation, stress, and loneliness monitoring.</p><p>In the last few years, ambient assisted living (AAL) technologies have become more and more popular, offering creative solutions to the problems associated with an aging population. In addition to supporting people in maintaining and pursuing their current activities, AAL technology has the potential to improve the quality and cost-effectiveness of health and social services, as well as enable people to continue participating in activities at home and in the community as they age. Despite the lack of a consensus definition for AAL, the phrase 'ambient assisted living' is frequently used in gerontechnological research and development. There are three generations in the development cycle of ambient assisted living.</p><table class='table table-responsive table-hover table-bordered'><tbody><tr><td>1st Generation AAL</td><td>Connectable devices<br /> Reacts to an emergency<br /> Needs user to sound alarms, etc.</td></tr><tr><td>2nd Generation AAL</td><td>Sensors for the home<br /> May feel intrusive<br /> Automated detection and response to emergencies</td></tr><tr><td>3rd Generation AAL</td><td>Wearable devices and home sensor integration<br /> Assistance and tracking for prevention<br /> Less obstructive</td></tr></tbody></table></div><p class='mt-4'>To enable people to live longer stay socially connected and age independently. AAL generally refers to the integration of information and communication technologies (ICT), stand-alone assistive devices, and smart home technologies into a person's everyday living and working environment. Through the integration of actuators, smart interfaces, artificial intelligence, and sensors, AAL creates supporting home environments. Traditional assistive technologies for individuals with disabilities, universal design approaches to accessibility, usability, and acceptability of interactive technologies, and the new ambient intelligence (AI) computing paradigm which offers pervasive, intelligent, and discrete assistance—are the foundations of AAL.</p><p>However, AAL technology has the potential to be adaptive to the varied nature of old age. It can anticipate and respond to the changing demands of older persons. Research on the possibilities of such technologies for healthy, frail, or dementia-stricken older persons has been limited to this point in AAL history. Research from the past has mostly overlooked how AAL technology might improve the daily lives of people with mild cognitive impairment (MCI). As long as daily activities are not hindered, mild cognitive impairment (MCI) is described as a noticeable loss in cognitive ability (e.g., memory, decision making, problem solving, and understanding). Up to 15% of adults over the age of 65 experience it, making it a problem for an important portion of the elderly population.</p><p>For individuals with motor cognitive impairment (MCI), successful assistance for independent living and aging in place is especially important because, in the event that it fails, it may keep them from experiencing severe pain and/or the high expenses of specialized care. With no viable pharmaceutical option at this time, AAL is the most appealing choice for offering this kind of support. But attempts to propose treatments are complicated because MCI refers to a variety of illnesses that show differently and are poorly understood. AAL technologies that are designed to help older persons with cognitive impairments (mostly MCI) with the difficulties they face in their daily lives, as well as AAL technologies that could be more broadly beneficial to that target people. Leveraging advancements in IoT (Internet of Things), AI, and machine learning, ambient sensor technology are growing more complex and adaptable. Numerous environmental parameters, including temperature, humidity, air quality, light levels, and even sound, can be monitored by these devices.</p><div class='mt-4'><h4>Usage of ambient sensors:</h4><hr class='mt-0' /><ol><li><p>Integration with Digital Homes: Ambient sensors are frequently included into the ecosystems of smart homes, enabling automated temperature, lighting, and cooling adjustments based on real-time data.</p></li><li><p>Health Evaluation: To improve health outcomes, certain sensors are made to monitor indoor air quality and can send out alerts about allergens, pollutants, or CO2 levels.</p></li><li><p>The Efficiency of Energy: By evaluating environmental factors and recommending or automating processes based on their findings, these appliances aid in an optimization of energy consumption.</p></li><li><p>Edge information technology: This technique, which is widely used in smart cities and industrial applications, reduces latency and use of bandwidth by processing information locally on a large scale.</p></li><li><p>User Privacy: Due to the growing emphasis on data privacy, many ambient sensors are made to collect as little personal data as possible while yet offering valuable information.</p></li><li><p>Wearable Technology: As ambient sensors are incorporated into wearable, individuals can now personally monitor the conditions around them and how they affect their health.</p></li></ol></div>

<h4>Introduction:</h4><hr class='mt-0' /><p>Physiotherapy is a dynamic field dedicated to restoring movement, function, and overall well-being. But at the heart of this practice lies not just technical expertise, but a powerful tool that guides informed decisions: clinical reasoning. It's a continuous cycle of inquiry, analysis, and adaptation, ensuring each patient receives a personalized approach to recovery.</p><h4 class='mt-4'>The Symphony of Clinical Reasoning:</h4><hr class='mt-0' /><p>Imagine a symphony where the patient's history forms the melody, the physical examination adds harmony and the physiotherapist's critical thinking acts as the conductor. Clinical reasoning orchestrates these elements into a cohesive treatment plan designed to address the root cause of the patient's dysfunction.</p><h4 class='mt-4'>The process unfolds in a cyclical fashion:</h4><hr class='mt-0' /><p>1. Data Collection:<br />History taking: This involves a comprehensive interview to understand the patient's presenting complaint, medical history, lifestyle factors, and social determinants of health.<br />Physical examination: Through various techniques, the physiotherapist evaluates movement patterns, joint integrity, muscle strength, sensation, reflexes, and other aspects relevant to the patient's condition.<br /><br />2. Hypothesis Generation: <br />Based on the gathered information, the physiotherapist formulates potential explanations for the patient's condition. These hypotheses should be grounded in current research evidence and consider the biopsychosocial model of health, encompassing biological, psychological, and social factors.<br /><br />3. Evaluation and Refinement:<br />The physiotherapist employs specific tests, observations, and sometimes even special investigations to confirm or refute the initial hypotheses. This stage might involve specific clinical tests, imaging referrals, or collaboration with other healthcare professionals for a more comprehensive picture.<br /><br />4. Treatment Planning:<br />Once a diagnosis is established, the physiotherapist designs a treatment plan tailored to the patient's specific needs and goals. This plan may include manual therapy techniques, therapeutic exercise prescription, education on pain management and self-care strategies, and potentially adjunctive therapies (e.g., modalities like ultrasound or electrical stimulation).<br /><br />5. Reassessment and Adaptation:<br />The physiotherapist continuously monitors the patient's progress and adjusts the treatment plan as needed. This iterative process ensures the treatment remains relevant and effective throughout the rehabilitation journey.</p><h4 class='mt-4'>The Power of Effective Clinical Reasoning</h4><hr class='mt-0' /><p>Mastering this intricate dance of information gathering, analysis, and intervention planning unlocks numerous benefits for physiotherapy care:<br />1. Improved Diagnostic Accuracy: Clinical reasoning leads to a deeper understanding of the underlying cause of dysfunction. By critically analyzing data and formulating well-defined hypotheses, physiotherapists can avoid mistaking symptoms for the root cause and design targeted treatments that address them.<br /><br />2. Individualized Care: Every patient presents with a unique story. Clinical reasoning allows physiotherapists to move beyond a one-size-fits-all approach. By considering the patient's specific needs, limitations, and goals, therapists can tailor treatment plans for optimal outcomes.<br /><br />3. Enhanced Patient Engagement: When patients understand the rationale behind their treatment plan and actively participate in decision-making, they become more invested in their rehabilitation journey. This collaborative approach fostered by clinical reasoning promotes ownership and empowers patients to actively participate in their recovery. <br /><br />4. Adaptability: The human body is a complex system, and situations can arise that deviate from textbook presentations. Strong clinical reasoning skills equip physiotherapists to think critically, adapt their approach on the fly, and adjust treatment plans as needed based on patient responses. Incorporating Clinical Reasoning into Practice: For aspiring and seasoned physiotherapists alike, fostering effective clinical reasoning requires a dedicated effort. Here are some practical steps to integrate this vital skill into daily practice:<br /><br />5. Build a Strong Knowledge Base: Staying current with the latest research findings and evidence-based practices is critical. A strong knowledge base allows physiotherapists to interpret data, formulate accurate hypotheses, and select appropriate interventions.<br /><br />6. Refine Active Listening Skills: Pay close attention to the patient's narrative. Listen not just to their symptoms, but also to their past experiences, current limitations, and desired outcomes. This information provides valuable clues for refining hypotheses and guiding the assessment process.<br /><br />7. Hone Observation Skills: Develop your ability to identify subtle details during physical examinations. Look for deviations in movement patterns, posture, muscle function, and joint integrity. These observations can significantly impact your clinical reasoning process and lead to more accurate diagnoses.<br /><br />8. Utilize Clinical Decision-Making Frameworks: Several frameworks can structure the clinical reasoning process. Some examples include the International Classification of Functioning, Disability, and Health (ICF) and the biopsychosocial model. These frameworks offer a systematic approach to analyzing patient data and formulating treatment plans.<br /><br />9. Embrace Reflection: Regularly evaluate your own decision-making processes. Reflect on successful cases and instances where the initial plan required adjustments. Consider what information was most helpful, what might have been missed, and how you could approach similar situations in the future. Reflecting on these experiences helps refine your clinical reasoning skills and identify areas for improvement.<br /><br />10. Seek Collaboration and Continuous Learning: Don't hesitate to consult with colleagues, other healthcare professionals, or refer to specialists when needed. Working together allows for a broader perspective and ensures the patient receives the best possible care. Additionally, commit to continuous learning through professional development courses, workshops, and staying updated with the latest research.<br /><br />11. Embrace the Unknown: Sometimes, patients present with complex or atypical presentations. Don't be afraid to acknowledge uncertainty and work collaboratively with the patient to navigate the path forward. Honesty and transparency build trust, and a willingness to explore different avenues showcases your commitment to finding the most effective approach.</p><p>Conclusion: Clinical reasoning in physiotherapy is not a rigid formula, but a dynamic process. Therapists continuously learn and adapt their approach, tailoring treatments to each patient's unique needs. This ongoing pursuit of knowledge fosters sharper critical thinking, leading to accurate diagnoses and personalized plans for faster recovery and improved well-being. Ultimately, clinical reasoning empowers both patients and therapists, making them partners in the journey towards optimal health.</p>

Volume-1, Issue-4

<h3>ABSTRACT:</h3><hr class='mt-0' /><h3>OBJECTIVE:</h3><hr class='mt-0' /><p>To Determine Prevalence of lower back pain among tractor driver.</p><h3>MATERIAL & METHODOLOGY:</h3><hr class='mt-0' /><p>For the study, a sample of 100 students was selected, regardless of their age and gender A observational study descriptive research design was used to collect data. In this case, the researchers collected data from around Amreli. To collect data, the researchers used a standardized, semi-structured questionnaire named the BPFS (back pain functional scale) and NPRS scale. This questionnaire consists of 12 questions, widely used to assess the lower back functional disability and pain among individuals.The questionnaire was distributed among the tractor drivers, and they were asked to fill it out honestly and without any external influence. Once the data was collected, it was analyzed using statistical methods to determine the prevalence of lower back pain among tractor drivers.The findings of the study were provided important insights of the low back pain status of tractor drivers.</p><h3 class='mt-4'>INTRODUCTION:</h3><hr class='mt-0' /><p>Low back pain is a common musculoskeletal symptom that may be either acute or chronic. It may be caused by a condition of diseases and disorders that affect the lumbar spine. Low back pain (LBP) is the most frequent work related musculoskeletal complaint and one of the leading causes of health related problems in developed world. Lower back pain is the leading cause of disability and inability to work and expected to affect up to 90 percentages of people at some point in their lives Tractor are being extensively used as a source of on road trasport in india. The vibration exposures among tractors are higher as compared to other on road vehicles Work-related complaints are a major problem facing employees and employers, which have negative impact on their health and productivity. One of the most common work-related complaints is musculoskeletal symptoms which affect nearly a million workers each year in the United States according to the US Bureau of Labour Statistics and accounts for 85% of all workers' compensation claims. To find effective treatments is a challenge for medicine. Exercise and spinal manipulation are often recommended, yet their clinical effectiveness has not been documented beyond reasonable doubt. Back pain among older adults not only impacts quality of life but often leads to subsequent functional impairment and disability. Measured functional impairments also include self-reported difficulties with activities of daily living (ADLs) and documented muscle weakness including trunk extensor muscles, lack of flexibility, slow walking gait, and slower measured functional capabilities Unlike younger adults, however, older adult back pain is less likely to be a result of injury or overuse and is often complicated by multiple chronic conditions, degenerative disc conditions, poor mental and/or physical health, and other functional impairments.</p><h3 class='mt-4'>METHOD:</h3><hr class='mt-0' /><p>To collect data, the researchers used a standardized, semi-structured questionnaire named the BPFS (back pain functional scale) and NPRS scale. This questionnaire consists of 12 questions, widely used to assess the lower back functional disability and pain among individuals.The questionnaire was distributed among the tractor drivers, and they were asked to fill it out honestly and without any external influence. Once the data was collected, it was analyzed using statistical methods to determine the prevalence of lower back pain among tractor drivers.The findings of the study were provided important insights of the low back pain status of tractor drivers.</p><h3 class='mt-4'>RESULT:</h3><hr class='mt-0' /><p>Among the total 100 respondents the average age of respondent was 25-65. I’ve conducted chi –square test among the two variables were BPFS scale and NPRS scale BPFS value is 49.5 and NPRS value is 37.4 . P-value is 0.001 is statistically significant. The percentage of scale indicate that BPFS is 60% and NPRS is 70%.The scores indicates that participants felt back pain during work.</p><h3 class='mt-4'>DISCUSSION:</h3><hr class='mt-0' /><p>This research aims to investigate the prevalence of lower back pain among tractor driver. The study utilized a observational study design, and data were collected using the BPFS questionnaire and NPRS. The study included 100 tractor driver in and around Amreli. The data analysis of NPRS revealed that among Tractor driver has average 1.47 score reported low back pain. The data analysis of BPFS revealed that among tractor driver has average 5.31 score reported low back pain. The data analysis BPFS revealed that among tractor driver, 60% reported low back pain.The data analysis NPRS revealed that among tractor driver , 70% reported low back pain.The results of the study showed that the prevalence of low back pain was high among in tractor driver .* 0 (0%) unable to perform any activity, 60 (100%) no difficulty in any activity. The high prevalence of low back pain among due to vibration and postural stress during driving</p><h3 class='mt-4'>CONCLUSION:</h3><hr class='mt-0' /><p>After collection and analyzing the data which were collected from tractor driver was found that the maximum number of tractor driver is suffering from low back pain.Whereas the number of tractor driver has raised level of low back pain.</p>

<h3>Introduction:</h3><hr class='mt-0' /><p>Cerebral palsy (CP) is a group of permanent movement disorders caused by early brain damage, typically occurring before or during birth or in the first few years of life. It affects motor control, muscle tone, and posture, leading to difficulties in movement and coordination. Given that CP stems from brain damage, many assume that motor deficits are fixed and irreversible. However, research into neuroplasticity—the brain’s ability to reorganize and form new neural connections—offers hope for improving motor function and overall quality of life in individuals with CP.</p><p>Neuroplasticity plays a crucial role in rehabilitation, especially in the context of pediatric patients whose brains are more adaptable. This article delves into the concept of neuroplasticity in cerebral palsy, exploring how it can be harnessed through various therapeutic interventions to promote functional improvement.</p><h3>Understanding Neuroplasticity in the Context of CP:</h3><hr class='mt-0' /><p>Neuroplasticity refers to the brain's ability to adapt by forming new connections between neurons. This ability is particularly pronounced in children, making early intervention critical in the treatment of cerebral palsy. In the case of CP, where certain areas of the brain are damaged, neuroplasticity allows undamaged areas of the brain to compensate for lost functions or take over motor tasks previously governed by the damaged regions.</p><p>Cerebral palsy affects the motor cortex, corticospinal tracts, and other areas responsible for movement and coordination. While these areas may be damaged, neuroplastic changes can be induced in adjacent or related brain regions through targeted rehabilitation efforts. By repeatedly engaging in specific motor tasks and sensory experiences, new neural pathways can be strengthened, leading to improved motor control and function.</p><p>Neuroplasticity is the underlying mechanism that supports many of the therapeutic interventions used in cerebral palsy rehabilitation, especially in physiotherapy and other motor-based treatments. The brain’s ability to remodel itself offers a window of opportunity for interventions aimed at improving motor function, even in the presence of early brain injury.</p><h3>Types of Neuroplasticity Relevant to CP:</h3><hr class='mt-0' /><div><p>There are two key types of neuroplasticity that are relevant in the treatment of cerebral palsy:</p><ul><li><p><strong>Adaptive Plasticity:</strong> This type of plasticity occurs when the brain adjusts in a beneficial way to compensate for damage. In CP, adaptive plasticity may involve recruiting undamaged areas of the motor cortex to take over functions previously managed by the damaged regions. Rehabilitative strategies aim to promote adaptive plasticity through repetitive training and sensory input.</p></li><li><p><strong>Maladaptive Plasticity:</strong> In contrast, maladaptive plasticity occurs when the brain reorganizes in a way that reinforces negative outcomes, such as abnormal movement patterns or increased muscle stiffness. For example, if a child with CP develops compensatory movement patterns that are inefficient or harmful, these may become ingrained through maladaptive plasticity. Therapy aims to mitigate these maladaptive changes by promoting correct movement patterns.</p></li></ul><p>The goal of neurorehabilitation in CP is to enhance adaptive plasticity while minimizing maladaptive plasticity, optimizing motor function and reducing the impact of the brain injury.</p></div><h3>Harnessing Neuroplasticity Through Early Intervention:</h3><hr class='mt-0' /><p>Early intervention is a key factor in promoting neuroplasticity in children with cerebral palsy. The earlier rehabilitation starts, the more likely it is that the brain will adapt to the injury and form new neural pathways. The developing brain is especially responsive to external stimuli and therapy during the early years of life, a period known as the “critical window” for neuroplasticity. This is when the brain has the highest capacity for forming new connections, and rehabilitation efforts can produce the greatest impact.</p><p>Physiotherapy is one of the most effective forms of early intervention in CP, as it directly targets motor function, muscle strength, and movement patterns. By using repetitive, task-specific exercises, physiotherapy helps reinforce new neural pathways and promotes adaptive plasticity in the motor cortex. Key elements of early intervention that facilitate neuroplasticity include:</p><ul><li><p>Motor Skill Training: Engaging the child in exercises that focus on motor control, coordination, and balance helps strengthen neural circuits involved in movement.</p></li><li><p>Task-Specific Therapy: Task-specific training, where the child practices functional tasks such as reaching, grasping, or walking, encourages the brain to adapt to specific movement patterns.</p></li><li><p>Sensory Stimulation: Sensory input, such as tactile stimulation or proprioceptive feedback, plays an important role in shaping neural development. Incorporating sensory stimuli in therapy helps enhance neuroplastic changes in motor pathways.</p></li><li><p>Assistive Technologies: Robotic devices and virtual reality can be used to guide movements in therapy, offering more controlled and consistent input to promote neuroplasticity.</p></li></ul><h3>Therapeutic Techniques to Enhance Neuroplasticity in CP:</h3><hr class='mt-0' /><p>Several therapeutic techniques in neurophysiotherapy are designed to harness neuroplasticity and improve motor function in children with cerebral palsy. These include:</p><ol><li><p><strong>Constraint-Induced Movement Therapy (CIMT):</strong> CIMT is a well-established therapy that forces the use of the affected limb by restricting the movement of the unaffected limb. By encouraging repetitive use of the affected limb, CIMT stimulates adaptive plasticity, promoting motor recovery. The therapy is particularly effective in children with hemiplegic CP, where one side of the body is more affected than the other.</p></li><li><p><strong>Task-Oriented Training:</strong> Task-oriented training involves practicing specific tasks, such as reaching for objects, grasping, or standing up from a seated position. The goal is to reinforce neural circuits involved in these actions through repetitive practice. This form of therapy is highly effective in promoting neuroplastic changes, as it mimics real-life activities and encourages the brain to form new connections.</p></li><li><p><strong>Robotic-Assisted Therapy:</strong> Robotic devices, such as exoskeletons or robotic arms, provide guided assistance during movement exercises. These devices offer consistent, repetitive movements that stimulate neuroplasticity by engaging motor pathways. Robotic therapy can be used to assist in walking, reaching, or other motor tasks, making it a valuable tool in CP rehabilitation.</p></li><li><p><strong>Functional Electrical Stimulation (FES):</strong> FES involves the use of electrical currents to stimulate muscle contractions in paralyzed or weakened muscles. The electrical stimulation activates motor neurons, promoting muscle movement and strengthening neural pathways. When combined with task-oriented training, FES can enhance neuroplasticity by facilitating motor recovery.</p></li><li><p><strong>Virtual Reality (VR) and Gamification:</strong> Virtual reality-based therapies provide an immersive environment where children can engage in therapeutic exercises in a fun and interactive way. By practicing motor tasks in a virtual setting, children are more motivated to participate, and the brain receives rich sensory input that enhances neuroplasticity. VR therapy has shown promise in improving motor function and engaging children in their rehabilitation.</p></li><li><p><strong>Neurodevelopmental Treatment (NDT):</strong> NDT is a hands-on approach used by physiotherapists to guide movement and improve motor control in children with CP. The therapist uses specific handling techniques to promote proper movement patterns and prevent compensatory strategies. By providing sensory feedback and facilitating correct movements, NDT helps reshape neural circuits in the motor cortex.</p></li></ol><h3 class='mt-4'>The Role of Caregiver Involvement in Promoting Neuroplasticity:</h3><hr class='mt-0' /><p>Caregivers play a crucial role in supporting neuroplasticity in children with cerebral palsy. Since therapy is most effective when practiced consistently, the involvement of parents and caregivers in carrying out therapeutic exercises at home is vital. Teaching caregivers how to integrate therapeutic activities into daily routines reinforces neural pathways and helps maintain the progress made during therapy sessions. Additionally, caregivers can provide emotional support and motivation, which are key factors in promoting engagement in therapy. The brain's response to rehabilitation is not only influenced by physical activity but also by the child's mental and emotional state. A positive and supportive environment enhances the potential for neuroplasticity.</p><h3 class='mt-4'>Challenges and Future Directions:</h3><hr class='mt-0' /><p>While neuroplasticity offers significant potential for improving motor function in children with cerebral palsy, challenges remain. Not all children respond to rehabilitation in the same way, and the extent of neuroplastic changes may vary depending on the severity of brain damage. Additionally, certain therapies, such as CIMT, can be intensive and may require substantial time and effort from both the child and caregivers. Future research should focus on identifying biomarkers that predict individual responses to therapy, allowing for more personalized interventions. Moreover, combining multiple therapeutic approaches—such as robotics, FES, and VR—into comprehensive rehabilitation programs could further enhance neuroplasticity and optimize outcomes for children with CP.</p><h3 class='mt-4'>Conclusion:</h3><hr class='mt-0' /><p>Neuroplasticity provides a powerful framework for understanding and treating cerebral palsy. By promoting adaptive changes in the brain, therapeutic interventions can improve motor function and overall quality of life in children with CP. Physiotherapy, task-specific training, and innovative technologies such as VR and robotics have shown significant potential in harnessing neuroplasticity. Early intervention, caregiver involvement, and a focus on personalized rehabilitation strategies are essential to unlocking the brain’s capacity for reorganization and improving outcomes for children with cerebral palsy.</p><div class='text-center'><img src='/assets/img/vol1_issue5_img1.png' class='mt-4' /><p>Picture:1 Constraint-Induced Movement Therapy (CIMT) technique in Cerebral Palsy</p><img src='/assets/img/vol1_issue5_img2.png' class='mt-3' /><p>Picture2:Neurodevelopment technique(NDT) technique in Cerebral Palsy</p></div>

<h3>ABSTRACT:</h3><hr class='mt-0' /><p>Background: Autism is a general term that is defined as a group of complex developmental brain disorders. Autism is associated with an inability to identify and distinguish one’s own feelings. Fewer studies exist with the purpose of providing an attitude towards autism measure aimed at a more general population.</p><p>Methodology: A link of a questionnaire was sent online to physiotherapy students. The questionnaire included questions about basic social attitudes, knowledge and personal distance with the people suffering from autism.</p><p>Results: The result was carried out by using Microsoft excel 2016. This study shows 89% of perception which is good towards autism. Results showed that there is good knowledge, attitude and perception towards autism among physiotherapy students.</p><p>Conclusion: This study concluded that there is good knowledge, attitude and perception towards autism among physiotherapy students.</p><p>Keywords: Knowledge, Attitude, Perception, Autism, Physiotherapy</p><h3 class='mt-4'>INTRODUCTION:</h3><hr class='mt-0' /><p>A neurodevelopmental illness known as autism spectrum disorder (ASD) is typified by limited, repetitive patterns of behaviour, interests, or hobbies, as well as ongoing difficulties in social communication and social interaction. Significant impairments in social interaction and communication, the presence of stereotypes and peculiar interests, and the emergence of symptoms in the domains of imaginative play and social communication development prior to the age of three are characteristics of autism. The prevalence of the condition is 0.62 percent worldwide. Up to 10% of children worldwide may have autism, a neurological disease that is somewhat frequent. It happens more often in boys than in girls. Eye contact, facial expressions, body postures, and gestures are the most important nonverbal behaviours impacted by qualitative social deficits during social interactions. Among the signs of communication impairments include the difficulty to strike up or carry on a conversation with others, the use of unusual or repetitive jargon, and a lack of impromptu pretend play. One or more stereotyped interest patterns, tight adherence to routines and rituals, stereotyped and repetitive motor mannerisms, and an ongoing fixation with object parts are examples of restricted repetitive and stereotyped behaviours and interests.</p><p>The intelligence quotient (IQ) of children with autism varies, and each child functions at a different level. Due to the diverse range of symptoms and severity associated with ASD, it is classified as a spectrum disorder. While 46% of people with autism earn average or above average scores on intelligence tests, some people with autism score poorly (CDC 2010). Thus, many people with ASD are capable of academic accomplishment, including success at the university level, provided the right supports are in place.</p><h3 class='mt-4'>MATERIALS & METHODS:</h3><hr class='mt-0' /><div><p>Following approval from the institutional ethical committee, an observational study was conducted using purposive sampling on physiotherapy students.</p><p class='mb-0'>Inclusion criteria:-</p><ol><li>People who are willing to participate</li><li>Physiotherapy students</li><li>Males and females</li></ol><p class='mt-3 mb-0'>Exclusion criteria:-</p><ol><li>Students who are not willing to participate</li><li>Physiotherapy practitioners</li></ol></div><h3 class='mt-4'>Procedure:</h3><hr class='mt-0' /><p>The duration of the study was one month, during which data of 158 sample size were collected among various physiotherapy students of Ahmedabad. Google form was sent online and data was collected. The google form questionnaire consisted of demographic details and Development of the Societal Attitudes towards Autism (SATA) Scale. The 26 item, SATA scale consists of questions about basic social attitudes, knowledge and personal distance with the people suffering from autism. 1 point was given for person who strongly disagrees to the question, 2 for person who disagrees to the question, 3 for person who agrees to the question and 4 for person who strongly agrees to the question. Thus, the possible scores ranged from 26 to 104. For reliability analysis of SATA scale, internal consistency was first calculated, producing a Cronbach’s alpha of 0.71.</p><h3 class='mt-4'>RESULT:</h3><hr class='mt-0' /><p>The result was carried out by using Microsoft Excel version 2016. Data was collected from various physiotherapy colleges of Ahmedabad. Results showed that out of 150 sample size, there is positive social attitude towards people with autism having score of 93%. 90% students had knowledge about autism. This study showed 89% of perception which is good towards autism. Results showed that there is good knowledge, attitude and perception towards autism among physiotherapy students.</p><div class='text-center mt-3'><img src='/assets/img/vol1_issue5_img3.png' /><img src='/assets/img/vol1_issue5_img4.png' class='mt-2' /><img src='/assets/img/vol1_issue5_img5.png' class='mt-2' /></div><h3 class='mt-4'>DISCUSSION:</h3><hr class='mt-0' /><p>The findings demonstrated that students pursuing physical therapy had positive attitudes, knowledge, and perceptions of autism. The general public does not view ADHD as a condition that requires identification, diagnosis, and treatment. Since comorbid mental disorders often coexist with ADHD, which is a chronic diagnosis, it seems sense that these conditions tend to arise later in life and worsen as a child gets older. The logical, hypothetical deductive reasoning and abstract thinking skills that are required of teens with ADHD in the classroom will surely be more difficult for them to develop.</p><p>According to a research by Malvi et al. (2023) on physiotherapists' awareness of autism, less than 50% of them have a general understanding of the condition. Additionally, individuals who work in pediatrics clinics possess greater awareness and knowledge than the other respondents.</p><p>A study on “knowledge, attitudes, and views of autism spectrum disorder” was carried out by Yingna Liu et al. (2016) in a stratified sample of Chinese preschool instructors. Preschool teachers in China showed less awareness about ASD in the study compared to a solid foundation in usual childhood development. For half of the questions about ASD in the questionnaire, most teachers were unable to give proper answers. Despite the present professional consensus that ASD has a significant genetic component, a conception of the condition as psychological in origin predominated. One reason for inaccurate understanding of the illness could be the Chinese names GuduZheng or ZibiZheng, which are used to describe autism. Both titles literally translate to 'loneliness disease' or 'isolation disease'</p><p>A study on college students was done by Devon White et al. in 2016. The study set out to investigate the knowledge and attitudes of university students regarding students who are autistic, to pinpoint the underlying causes of these attitudes, and to see if these attitudes altered over a five-year span. Our hypothesis that students in the later cohort would have more positive views toward their peers on the autistic spectrum and better information about ASD due to the increased prevalence and awareness of ASD was validated. On the other hand, attitudes and knowledge (as determined by the quantity of correctly identified qualities) did not significantly correlate. Taking cohort and gender into account did not change the significance of this association.</p><h3 class='mt-4'>CONCLUSION:</h3><hr class='mt-0' /><p>This study concludes that there is good knowledge, attitude and perception of Autism among physiotherapy students. Thus there is strong need to bring knowledge and awareness of ADHD among community. Correct knowledge, attitude and perception towards helps physiotherapy students to design correct plan and treatment in clinical practice.</p><div><p>Declaration by Authors</p><ul><li>Ethical Approval: Approved</li><li>Acknowledgement: None</li><li>Source of Funding: None</li><li>Conflict of Interest: The authors declare no conflict of interest.</li></ul></div>

<h3>ABSTRACT:</h3><hr class='mt-0' /><p>Low back pain (LBP) is a prevalent issue among postmenopausal women, significantly affecting their quality of life (QoL) and overall functionality. This study delves into the intricate relationship between pain disability, QoL, and Q-angle within this age group. Over six months, 150 postmenopausal women were recruited from a community health center for this observational study. Pain disability was meticulously assessed using the Oswestry Disability Index (ODI), QoL was evaluated through the SF-36 questionnaire, and the Q-angle was measured with precision using a goniometer. The analysis, conducted using Pearson correlation coefficients, unveiled significant correlations: a strong negative correlation between pain disability and QoL (r = -0.65, p < 0.01), a moderate positive correlation between pain disability and Q-angle (r = 0.34, p < 0.05), and a modest negative correlation between QoL and Q-angle (r = -0.29, p < 0.05). These findings indicate that greater pain disability is linked to poorer QoL and an increased Q-angle in women experiencing LBP. This study underscores the critical need for comprehensive management strategies that address these factors to enhance patient outcomes in this population.</p><p>Keywords: Low Back Pain, Postmenopausal, Quality of Life, Pain Disability, Q-angle.</p><h3 class='mt-4'>INTRODUCTION:</h3><hr class='mt-0' /><p>Low back pain (LBP) is a global health issue, particularly prevalent among women aged 50-60 years. This age group undergoes significant physiological changes due to aging, such as decreased bone density and altered muscle function, which contribute to the onset and persistence of LBP. Understanding the underlying factors associated with LBP in this demographic is vital for developing targeted and effective interventions. One crucial factor is the Q-angle, the angle formed by the quadriceps muscle and the patellar tendon. An increased Q-angle can disrupt lower limb biomechanics, potentially leading to LBP. Additionally, pain disability and quality of life (QoL) are pivotal outcomes that significantly affect the overall well-being of individuals suffering from LBP.</p><p>This study aims to explore the intricate relationships between pain disability, QoL, and Q-angle in adults aged 50-60 years, shedding light on the complex interplay of these factors. By investigating these correlations, we hope to provide valuable insights that can inform the development of comprehensive management strategies for this population, ultimately enhancing patient outcomes and quality of life. The findings of this research could pave the way for more effective treatments and interventions, addressing the multifaceted nature of LBP in postmenopausal women.</p><h3 class='mt-4'>METHODOLOGY:</h3><hr class='mt-0' /><p>This study focused on a population of postmenopausal women aged 50-60 years who were experiencing low back pain (LBP). The sample size consisted of 150 participants, which was determined through a power analysis aimed at detecting medium effect sizes with 80% power and a significance level of 0.05. Data collection was carried out through face-to-face interviews and physical examinations at a community health center. Participants completed standardized questionnaires, and their physical measurements were conducted by trained healthcare professionals to ensure accuracy and reliability.</p><p>Participants were recruited over six months using a convenience sampling method, specifically from the outpatient department of the Health Centers. To ensure the suitability of participants, a rigorous screening process was implemented. This included evaluating their medical history and conducting physical examinations. Individuals with severe comorbidities, such as cancer or severe cardiovascular disease, recent surgeries within the past six months, or cognitive impairments that would affect their ability to complete questionnaires were excluded from the study.</p><p>The inclusion criteria required participants to be postmenopausal women aged 50-60 years, experiencing LBP for at least three months, and capable of providing informed consent. This thorough and meticulous approach ensured that the study population was well-defined and relevant to the research objectives, providing a robust foundation for examining the correlations between pain disability, quality of life, and Q-angle in this demographic.</p><h3 class='mt-4'>STATISTICAL ANALYSIS:</h3><hr class='mt-0' /><p>Data analysis was conducted using SPSS version 26. Descriptive statistics provided a comprehensive summary of the sample characteristics, offering a clear overview of the participant demographics and key variables. To explore the relationships between pain disability (measured by the Oswestry Disability Index), quality of life (assessed via the SF-36 questionnaire), and Q-angle, Pearson correlation coefficients were calculated. The significance of these relationships was determined with a p-value threshold of <0.05, ensuring statistical rigor and reliability. This approach allowed for a nuanced understanding of the interplay between these critical factors in the study population.</p><h3 class='mt-4'>RESULTS:</h3><hr class='mt-0' /><div><ol><li>Descriptive Statistics</li><p>Table 1 presents the demographic and clinical characteristics of the study participants.</p><img src='/assets/img/vol1_issue5_img6.png' /><li>Correlation Analysis</li><p>Pearson correlation coefficients revealed significant relationships between the variables of interest (Table 2).</p><img src='/assets/img/vol1_issue5_img7.png' /></ol></div><h3 class='mt-4'>DISCUSSION:</h3><hr class='mt-0' /><p>The findings indicate a significant negative correlation between pain disability and QoL, suggesting that as pain disability increases, QoL decreases. This aligns with previous studies highlighting the impact of LBP on QoL in adults aged postmenopausal women. Additionally, the positive correlation between pain disability and Q-angle suggests that an increased Q-angle may contribute to greater pain disability, potentially due to altered lower limb biomechanics. The negative correlation between QoL and Q-angle further supports the detrimental impact of increased Q-angle on overall well-being.</p><h3 class='mt-4'>CONCLUSION:</h3><hr class='mt-0' /><p>This study demonstrates significant correlations between pain disability, QoL, and Q-angle in postmenopausal women with LBP. These findings underscore the importance of comprehensive management strategies addressing these factors to improve outcomes in this population. Further research is needed to explore the underlying mechanisms and develop targeted interventions.</p>

<h3>Introduction:</h3><hr class='mt-0' /><p>Fast bowling is a distinct and high-powered movement pattern used in the sport of cricket that is characterized by vigorous trunk actions, strong vertical ground reaction forces, and high workloads. Due to their intense play, fast blowers are more vulnerable than other players to suffer significant injuries. lumbar stress fracture (LSF) is the type of such injuries that occurs as a result of such vigorous activity. LSF accounts for 3% to 12% of all cricket injuries. These injuries develop as a result of overuse injuries caused by microdamage accumulation and propagation in bone, and their severity varies according to the bone stress continuum, resulting in stress responses to partial and complete lumbar stress fractures (LSF) . In a study by Alway et al., the incidence of lumbar stress fractures among English county cricket fast bowlers was 1.67% (57 lumbar stress fractures) all over the entire squad of 368 fast blowers, with match incidence of 0.13 per 10,000 balls, yearly incidence of 2.46 per 100 fast bowlers, and match incidence of 0.13 per 10,000 balls between 2010 and 2016. They further, found that fast bowling has been linked to an asymmetrical bone stress response, with injuries occurring more frequently on the bowling arm's contralateral side (93% of injuries), in the pedicle (23%), the pars inter articularis (77%), and the L4 (35% and L5 (32%) 11. Another study found that fast bowlers had significant lumbar bone mineral despite the high frequency of Lumbar bone stress injuries (LBSI), with up to 14.6% and 18.1% more bone mineral density (BMD) and bone mineral content (BMC) on the side opposite and the bowling arm, respectively. Such an injury usually results in pain, time loss from sporting events, and activity constraints.</p><h3 class='mt-4'>Risk factors</h3><hr class='mt-0' /><p>Age has a key role in bone stress injury in athletes under the age of 25. The lumbar spine does not fully develop until the age of 25. With an annual incidence of 4.90 stress fractures per 100 fast bowlers, individuals aged 18-22 are most at risk of lumbar stress fracture. There may also be a metabolic problem causing insufficient calcium and vitamin D synthesis and absorption, which affects bone density. The bowler may have tightness and decreased mobility, strength, or control in his hips, ankles, upper back, or shoulders, and he substitutes through that area of the spine15. Specific biomechanical aspects of the bowling technique, such as increased shoulder counter-rotation and trunk lateral flexion, are suggested risk factors for LBSI. Compared to bowlers who use side on and front on bowling actions, bowlers with mixed bowling actions are at greater risk. It has been hypothesized that bowlers with a high workload during their first 90 days and a low workload throughout their careers are far more likely to experience LSF. It is vital to understand the relationship between workload and injury risk so that workload recommendations may be developed to reduce injury risk.</p><h3 class='mt-4'>Symptoms of lumbar bone stress injury:</h3><hr class='mt-0' /><ol><li>localized back pain on the side opposite the bowling arm that develops gradually.</li><li>The pain usually gets worse with activity and improves with rest.</li><li>Bowling aggravates pain due to hyperextension of the lumbar spine.</li></ol><h3 class='mt-4'>Diagnosis:</h3><hr class='mt-0' /><p>A diagnosis of LBSI or LSF typically involves obtaining a complete history and physical examination by the team's medical doctor or a physical therapist. Imaging tests such as X-rays, Magnetic resonance Imaging (MRI) Computed tomography (CT), and bone scans may also be ordered to confirm the diagnosis.</p><p>In some cases, LBSI may be asymptomatic. This means that the athlete does not have any symptoms, but the fracture is still present. Asymptomatic LBSI is more common in young athletes, and it can be difficult to diagnose. In these asymptomatic cases, the presence of bone marrow oedema (BMO) on MRI scans at the posterior vertebral arch of pars inter articularis indicates the presence of acute bone stress in the corresponding lumbar vertebral segment 20. The severity of the LBSI increases with the severity and extent of BMO observed at the posterior vertebral arch. On the other hand, in fast bowlers, symptomatic lumbar pars interarticular lesions at L4 and L5 are clinically significant overuse injuries. Furthermore, 11% of a cohort of young adult fast bowlers examined with CT scans over the course of a 12-month study reported having symptomatic pars lesions In fast blowers' development of symptomatic lumbar pars lesions, in particular unilateral L4 stress lesions, are strongly correlated with fast bowling. Stress lesions of the L1-L3 pars have also been identified by isotope bone scans in bowlers presenting with low-back pain.</p><h3 class='mt-4'>Management:</h3><hr class='mt-0' /><p>The recommended standard care for an acute stress fracture is a period of rest, review of bowling technique, and rehabilitation, usually extending over a period of 4 to 6 months. Return to play before the recovery period is completed increases the likelihood of the athlete developing recurrent injury in the same location as a result of inadequate bone strength. Consequently, the possibility of a subsequent rehabilitation phase and another repeated cycle of conservative treatments will jeopardize their professional career. Many cricketers with chronic, well-established pars defects may be asymptomatic, allowing for maximum performance with little restrictions. In some cases, hypermobility of the posterior vertebral segments can cause pain and limit the athlete's activity. These athletes are often managed symptomatically, which requires a brief period of rest until symptoms vanish and then a gradual return to play with pain persists sometimes. However, in these acute or symptomatic cases of chronic spondylolysis recurrence, surgical intervention may be required to facilitate a more robust and long-lasting recovery. Conservative treatment of pars lesions produces excellent clinical outcomes in the majority of athletes, with sports resumed within 6 months after injury. Surgery is recommended when an athlete presents with pain and a history of lumbar pars/pedicle stress fractures which is limiting the ability to bowl at a professional level.</p><h3 class='mt-4'>Rehabilitation:</h3><hr class='mt-0' /><p>Here is a broad summary of the rehabilitation process of lumbar stress fractures in cricket fast blowers:</p><ol><li><p>Pain management and rest: The first phase of rehabilitation focuses on managing pain and rest. This could involve using cold, heat, or over-the-counter medications for pain relief.</p></li><li><p>Core muscle strengthening: Once the pain has decreased, the next phase of therapy focuses on strengthening the core muscles. Exercises like planks, bridges, and bird dogs can help with this.</p></li><li><p>Reintroduction of activities: As the fracture heals, the bowler can begin to gradually reintroduce more strenuous activities like light bowling and running.</p></li><li><p>Return to Sport: The final phase of rehabilitation focuses on returning to full bowling. This can include progressively increasing the intensity and duration of bowling sessions.</p></li></ol><p>It is important to work with a physical therapist who is experienced in treating lumbar stress fractures in cricket fast bowlers. The physical therapist can help to create a personalized rehabilitation program that will help to recover from injury and return to full bowling.</p><h3 class='mt-4'>Conclusion:</h3><hr class='mt-0' /><p>Lumbar stress fractures are an injury that can significantly impact the careers of fast bowlers in cricket. Early identification and proper management are essential to prevent long-term complications and improve the athlete's quality of life. The combination of proper diagnosis, treatment, and rehabilitation can improve an athlete's chances of returning to their pre-injury level of performance.</p>

<h3>Abstract:</h3><hr class='mt-0' /><p>Transverse myelitis is basically inflammation of spinal cord which results in varying degree of symptoms like weakness in limbs, bowel bladder involvement, sensory deficits depending upon the lesion.</p><p>A 52-year-old female came to outpatient department of hospital with complain sudden weakness and feeling of heaviness in bilateral lower limbs with loss of sensations in both feet and was unable to walk without support. There was also a complaint of a cotton wool-like sensation in both feet. Patient came to the outpatient physiotherapy department with complaints of paraesthesia in the plantar aspect of feet, unable to walk independently, difficulty in maintaining balance while walking indoors and outdoors, difficulty in getting up from the chair, unable to get up from the floor. During the examination by a physiotherapist, it was found that the range of motion of all the joints for the upper and lower limbs were full passively whereas there was reduced muscle strength in bilateral lower extremity and trunk muscles. Berg balance score was 15/56 along with fatigue severity scale 51/63 The rehabilitation programme was of 1-1.5 hours per day under physiotherapist guidance for 6 weeks which comprised 6 days per week for the first three weeks and then it was reduced to 3 days per week for the last three weeks. The primary goal is to improve the functional capabilities and level of fatigue of the patient. The home-based treatment protocol was also designed on tailor made protocol and was modified according to the progression of the patient's ability. The progression in functional abilities and endurance were assessed initially in the first week then after every 2 weeks consequently during the rehabilitation programme.</p><p>Keywords- activities of daily living , functional training, muscle training, physiotherapy, spinal cord injury</p><h3 class='mt-4'>Case Description:</h3><hr class='mt-0' /><p>A lady of 52 years of age with a history of sudden weakness and feeling of heaviness in bilateral lower limbs with loss of sensations in both feet and was unable to walk without support. There was also a complaint of a cotton wool-like sensation in both feet. She was admitted to the hospital for 5 days and medically managed with intravenous steroids, analgesics and anti-viral medications. MRI findings confirmed acute transverse myelitis with visible lesions on her spinal cord. Reports are not available as they are with insurance company for claim settlement. After 5 days the patient was referred for physiotherapy. The patient came to the outpatient physiotherapy department with complaints of paresthesia in the plantar aspect of feet, unable to walk independently, difficulty in maintaining balance while walking indoors and outdoors, difficulty in getting up from a chair, unable to get up from the floor. Symptoms like low back pain, tingling, and numbness subsided after medical management. There was a history of transverse myelitis for 1 year which was medically managed without any residual symptoms.</p><p>During the examination by a physiotherapist, it was found that the range of motion of all the joints for the upper and lower limbs was passively full. In contrast, there was reduced muscle strength in the bilateral lower extremity and trunk muscles. The strength of the bilateral upper limb was grade 5. The examination was focused on muscle strength, balance, functional assessments, gait, and endurance. (Table – 1 and Table – 5)</p><img src='/assets/img/vol1_issue5_img8.png' class='img-fluid' /><p class='mt-2'>The results of muscle strength assessment suggested that patient had weakness of bilateral lower extremities, with greater weakness in left lower extremity than right. This reduced muscle strength may have reduced functional abilities and activity of daily living of the patient like walking, transfers, and maintaining balance. (Table – 2) Based on the complaints of the patient regarding tingling and feeling of heaviness, a sensory examination was conducted which did not show prominent findings. The patient didn’t have any fecal or urinary incontinence. The patient presented with gait deviations like being unable to walk without support, difficulty in walking along a straight path, walking with a wide base of support with hyperextension of the knees, and a significant reduction in endurance and speed. The prognosis of the patient was fair related to the findings gathered on taking certain outcomes and looking at the strength of muscles. Given the nature of transvers myelitis (TM), progression to the plateau of symptoms and recovery is unknown and different for each patient.</p><img class='img-fluid' src='/assets/img/vol1_issue5_img9.png' /><h3 class='mt-4'>Rehabilitation Programme:</h3><hr class='mt-0' /><p>Written informed consent was obtained from the patient prior to starting of rehabilitation programme. The rehabilitation programme was of 1-1.5 hours per day under physical therapist guidance for 6 weeks which comprised of 6 days per week for the first 3 weeks and then it was reduced to 3 days (i.e. alternate days) per week for the last 3 weeks. (Table – 3) The primary goal of physiotherapy is to improve the functional capabilities and level of fatigue of the patient. The dosage of therapeutic exercise varied according to the fatigue level of the patient during the physiotherapy session. The therapeutic exercise included strengthening, endurance training, balance and gait training. The home-based treatment protocol was also advised for the patient which was modified according to the progression of the patient’s ability. (Table – 4) The progression in functional abilities and endurance were assessed using the following outcome measures which were taken initially in the first week then after 2 weeks, after 4 weeks and after 6 weeks consequently during the rehabilitation programme. The dosage for some of the exercises performed is not specified and progressed according to the tolerance level of the patient because of fluctuations in fatigue level.</p><img src='/assets/img/vol1_issue5_img10.png' class='img-fluid' /> <img src='/assets/img/vol1_issue5_img11.png' class='img-fluid' /> <img src='/assets/img/vol1_issue5_img12.png' class='img-fluid' /><img src='/assets/img/vol1_issue5_img13.png' class='img-fluid mt-3' /> <p>*Intensity for HEP was based on tolerance level of the patient and also fatigue.</p><h3 class='mt-4'>Outcomes:</h3><hr class='mt-0' /><p>Patient progression in an objective manner after full rehabilitation is summarized in the table – 5. On the whole patient demonstrated increased muscle strength and endurance and also ease in her activities of daily living.</p><img src='/assets/img/vol1_issue5_img14.png' class='img-fluid' /><p>* NT – not tested</p><p>Based on the subjective assessment patient reported that there was significant improvement in her independence in performing activity of daily living like dressing, bathing, cleaning and washing utensils in standing, cooking, stair ascending and descending and also in her fatigue level at the end of her day even after performing all her routine tasks and walking.</p><h3 class='mt-4'>Discussion:</h3><hr class='mt-0' /><p>Acute transverse myelitis (ATM) is a neurological syndrome due to inflammation of the spinal cord and symptoms may vary depending upon the level of involvement. It is characterized by acute or sub-acute motor, sensory, and autonomic (bladder, bowel, and sexual) spinal cord dysfunction. The clinical signs are caused by an interruption in ascending and descending neuroanatomical pathways in the transverse plane of the spinal cord, and a resulting sensory level is characteristic of the syndrome. The degree of disability in patients with transverse myelitis depends on the level of involvement in spinal segments. High doses of intravenous corticosteroids such as prednisone, cyclophosphamide, and plasma exchange are therapeutic options in the medical treatment of ATM. The aim of rehabilitation is increasing strength, and endurance, improving coordination and balance with gait retraining, and preventing secondary complications like chest infections, contractures, atrophy, bed sores, etc.</p><p>This case report is based on evidence based rehabilitation of patient with transverse myelitis with subjective and objective outcomes and plan of care. As there are limited literature review demonstrating further rehabilitation for this condition but the available research work focuses on activity based and impairment based rehabilitation. Physiotherapy need to incorporate activity based rehabilitation along with strengthening, passive and active range of motion exercises, endurance exercise and neuromuscular re-education. Since this case was reported in India where there is importance of sitting on the floor and on low stool for activities of daily living like bathing, toileting and also for religious practices imbibed this activity as treatment strategy for overall rehabilitation. For an instance when we are more focused towards functional based training it is important to transfer the task in different context and environment to achieve our goal more efficiently and helping individual to gain independence. The treatment protocol in this case is specifically tailored according to the activity limitations and participation restrictions area of the patient as mentioned in the International classification of functioning matrix structured as per patient needs. Fatigue is a common symptom reported in most of the patients and a predictor of quality of life. It is also an important factor which can lead to further limitations in day to day activities and participation focus on fatigue management and energy conservation techniques at home and during rehabilitation is also addressed. We emphasized on the transition of these therapeutic exercise to be useful in routine functioning of the patient and relevant in tasks of daily living. However, the goal of physiotherapy is to optimize the neurological recovery and functions of day to day activity of the patient. The major aim of our rehabilitation was to orient our patient back to community with underlying residual neurological symptoms and gain independence. In the process of training an individual to gain maximum independence we need to consider the entire motor and sensory component along with biomechanical properties of muscles, environmental context along with primary and secondary impairments and also various other compensatory and restorative facets.</p><h3 class='mt-4'>Conclusion:</h3><hr class='mt-0' /><p>This case report demonstrates the benefits of physiotherapy in patients with transverse myelitis. It also illustrates the importance of activity based rehabilitation along with strength and endurance training. However, more research is needed to obtain long term benefits of physiotherapy in patients with transverse myelitis.</p>

Issue 1	March, 2024
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