Bhamini K. Rao

Effect of strength and balance training in children with Down's syndrome: a randomized controlled trial

Objective: The aim of the study was to determine the effect of exercise training on strength and balance in children with Down’s syndrome. Design: Randomized controlled trial. Setting: Rehabilitation school for special children. Subjects and intervention: Twenty-three children were randomized to intervention and control group. The intervention group (n = 12) underwent progressive resistive exercises for lower limbs and balance training for six weeks. The control group continued their regular activities followed at school. Outcome measure: A handheld dynamometer was used to measure the lower limb muscle strength. Balance was assessed by the balance subscale of Bruininks Oseretsky Test of Motor Proficiency (BOTMP). Results: Following the training, the children in the intervention group showed a statistically significant improvement (P < 0.05) in the lower limb strength of all the muscle groups assessed. The strength of knee extensors was 12.12 lbs in the control group versus 18.4 lbs in the experimental group; in hip flexors it was 12.34 lbs in the control group versus 16.66 lbs in the experimental group post-intervention. The balance of the children also improved significantly with an improvement in scores of the balance subscale of BOTMP (19.50 in the experimental group versus 9.00 in the control group, P = 0.001). Conclusion: This study suggests that a specific exercise training programme may improve the strength and balance in children with Down’s syndrome

Analysis of Postural Stability in Children With Cerebral Palsy and Children With Typical Development: An Observational Study

Purpose: To analyze and compare postural stability during static upright standing between children with cerebral palsy (CP) and age-matched peers with typical development (TD). Methods: Forty-five children with spastic CP (34 with diplegia and 11 with hemiplegia) and 45 children with TD aged 5 to 12 years were assessed using a posturography device. Postural stability was evaluated under 4 sensory conditions: eyes open and eyes closed on a firm surface; eyes open and eyes closed on a foam surface. Results: Statistically significant differences were obtained between children with spastic diplegic CP and children with TD under all conditions involving visual and somatosensory conflicts (P < .05), but no significant differences were found between children with hemiplegic CP and children with TD. Conclusion: Children with spastic diplegic CP have increased postural instability under sensory conditions that involve both visual and somatosensory conflicts.

Chest physiotherapy techniques in neurological intensive care units of India: A survey

Context: Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs. Aim: The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India. Settings and Design: A tertiary care hospital in Karnataka, India, and cross-sectional survey. Subjects and Methods: A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India. Statistical Analysis Used: Descriptive statistics. Results: The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists. Conclusions: Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.

Short-term balance training with computer-based feedback in children with cerebral palsy: A feasibility and pilot randomized trial

ABSTRACT Objective: To assess the feasibility of using short-term balance training with computer-based visual feedback (BTVF) and its effect on standing balance in children with bilateral spastic cerebral palsy (BSCP). Methods: Out of the fourteen children with BSCP (mean age = 10.31 years), seven children received four sessions of BTVF (two such sessions/day, each session = 15 min) in comparison to the control group that received standard care. Feasibility was measured as percentages of recruitment, retention and safety and balance was measured using a posturography machine as sway velocity (m/s) and velocity moment (m/s2) during quiet standing. Results: No serious adverse events occurred in either group. There were no differences in the retention percentages and in any clinical outcome measure between both groups. Conclusion: Use of BTVF is feasible in children with BSCP but further investigation is required to estimate a dose–effect relationship.

Prevalence of Pelvic Floor Dysfunction among Married Women of UdupiTaluk, Karnataka, India

Background: Pelvic floor dysfunction predominantly affects women of all the ages with an increasing prevalence with advancing age. Very few studies on prevalence of urinary incontinence have been conducted in India and none in Udupi taluk. Aim: The aim of this cross-sectional study is to estimate the prevalence of Pelvic Floor Dysfunction among married women of Udupi taluk, Karnataka, India and to evaluate the impact of age, educational qualification, occupation, parity and mode of delivery on pelvic floor dysfunction. Materials and Methods: A cross-sectional study was conducted on 1256 married women using a structured questionnaire. Women were interviewed at their residence using the questionnaire. Institutional ethical committee approval and written informed consent was obtained before the interview. Result: Prevalence of pelvic floor dysfunction was reported to be 21% with 19.02% of the women experiencing urinary incontinence and 1.99% experiencing pelvic organ prolapse. The mean age of the women participated in this study was 45.4 ± 11.8 (ranging between 18-70 years). Eighty seven percent of the women were housewives and 69% of the women had only primary education. Statistically significant association was found between age (p ≤ 0.001), occupation of the women (p ≤ 0.001), presence of urinary incontinence during pregnancy which disappeared after delivery (p=0.009) and occurrence of at least one type of pelvic floor dysfunction. Age, occupation and presence of symptom of urinary incontinence during pregnancy which disappeared after the delivery were reported as the independent predictor of symptoms of pelvic floor dysfunction when analyzed with multivariate logistic regression model. Conclusion: Prevalence of pelvic floor dysfunction among women of Udupi Taluk, Karnataka, India was found to be 21% with age, occupation and presence of symptom of urinary incontinence during pregnancy which disappeared after the delivery as the independent predictor of symptoms of pelvic floor dysfunction.

Papel do exercício combinado sobre a dor de dismenorréia primária em mulheres jovens: uma quase-experiência

INTRODUCTION: Primary dysmenorrhea is the pain of lower abdominal before and during the menstruation. Primary dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful. OBJECTIVE: The purpose of this study was to investigate effects of selected exercise on primary dysmenorrhea pain among girl. METHODS: Young women aged (21.1±2.0) were included in this study. The intervention with exercises included core strengthening, flexibility, kegel and endurance exercises. The duration of the intervention was eigth weeks, two times per week with duration of 30 minutes per session. Visual Analogue Scale (VAS) was used to measure the intensity of pain. RESULTS: The results show that exercise effects to reduce pain intensity among young women with dysmenorrhea. There was a significant difference in the score for pre-test (M: 6.94, SD: 1.33) and post-test (M: 5.02, SD: 1.15) conditions; t (9.1) = 2.34, p= 0.000. CONCLUSION: This study shows that the mixed exercise of flexibility, core stability and kegle exercise can reduce the primary dysmenorrhea pain among girls.

Energy expenditure during standing in children with cerebral palsy: A brief report1.

PURPOSE The aim of the study was to estimate the energy expenditure (EE) during a quiet standing task in children with bilateral spastic CP (BSCP) in comparison with typically developing (TD) children, using gas analyzer. METHODS The study was an observational cross-sectional study of children with BSCP (Gross Motor Function Classification System [GMFCS] levels II and III; n = 30; 10 males, 20 females; mean weight 27.46 kgs; mean age 10 years) and TD children (n = 30; 16 males, 14 females; mean weight 25.35 kgs; mean age 9 years, 9 months). The energy expenditure during quiet standing task was measured by using Cosmed K4b2 gas analyzer and expressed in terms of peak oxygen consumption (VO2 max, ml/kg body weight/min). RESULTS Children with BSCP expended 1.4 times higher energy during standing than TD children (p< 0.0001). CONCLUSION We identified that standing puts an additional energy demand in ambulant children with BSCP. Findings suggest that both dependant and independent ambulating children with BSCP might need to exert more effort to maintain a static standing position. Therefore, clinicians must evaluate standing position for balance control and energy expenditure to evaluate the efficiency of physical therapy and rehabilitation.

Mobilization of patients in neurological Intensive Care Units of India: A survey

Context: The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs) vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. Aim of the Study: To study the current mobilization practices by the physiotherapists in neurological ICUs of India. Subjects and Methods: A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. Results: Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%). Eighty participants (97.6%) mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%), “always” provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5%) used tilt table “sometimes” to introduce orthostatism for their patients. Conclusion: Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.