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Annals of Physiotherapy And Occupational Therapy

ISSN(p): | ISSN(e):2640-2734
Journal Papers (82) Details
Indexed Journal

1 Improving Parent Competence with a Community-Based Group Parent Training Program , Colwell C*
This pilot study investigated the impact of a parent training program that focused on helping parents use child development information to identify care giving issues and set goals to improve their parent-child interactions. The community-based program provided group education on parenting topics, a structured goal setting process, and individual coaching. After six weeks, the participants recorded more competence with parenting, improved goal performance, and more satisfaction with their parent-child interactions. A follow-up with the parents one year later revealed that they were continuing to benefit from the education and coaching program. These findings support the use of parent training programs to improve parents’ ability to monitor and adapt their parent-child interactions to meet their children’s changing needs.
2 Patient Perceptions Regarding Viscosupplementation for Treatment of Osteoarthritis of the Knee , Bonier JR*, Bonier JH and Habusta SF
Viscosupplementation as a treatment for knee osteoarthritis is widely used, though current literature is controversial regarding its efficacy. The purpose of this study was to evaluate patient perceptions regarding viscosupplementation as a treatment for knee OA. A questionnaire was administered randomly to 200 patients of a community-based orthopedic practice. Items focused on subjective patient outcomes in regard to their experience with viscosupplementation, as well as WOMAC symptom scores. One hundred and fifteen completed surveys were returned (response rate = 57.5%). Fiftyone patients (44.3%) reported some relief of symptoms and 18 patients (15.7%) reported large relief. Fifty-eight patients (50.4%) described their relief as lasting 1-4 weeks, with only 15 patients (13.0%) reporting 6 or more months of relief. Fifty-three patients (46.1%) stated they had more symptom relief with viscosupplementation when compared to corticosteroid injections. One hundred and ten patients (95.7%) had no prior surgery for knee OA. Ninety-two patients (80.0%) had not experienced any adverse effects. One hundred and eight patients (93.9%) stated they felt the treatment was worth the cost. One hundred and one patients (87.8%) said they would recommend viscosupplementation to another patient. Average WOMAC scores for patients who responded with no relief of symptoms was 80.4, while the average WOMAC score was 8.6 for those responding with complete relief.In conclusion, viscosupplementation has a positive treatment effect, possibly placebo, in a majority of patients, especially those with milder symptoms, and may provide improved symptom relief when compared to corticosteroid injections. More affordable viscosupplementation options must be investigated in the future.
3 Do they know us? , Rod Charlie DR*
Occupational therapy and physical therapy are two distinct fields in rehabilitation that were developed for a long time already and continue to evolve as the needs and further research on their efficacy to promote change unfolds. However, despite the increasing number of therapists all over the world, there are still confusions between the two professions, and even more alarming, is that in some areas especially in the developing countries, these fields are not yet fully recognized and understood. The question of, “Do they know us?” still exists. Hence, advocacy movements towards awareness and correcting misconceptions is still relevant and will always be relevant as long as therapists continue to pose their worth in the field of health.
4 Dig Harder! Win the War, not Just a Few Battles, on Effective Interventions for Multi-system Problems, in the Chronic Patient , Hickey CJ*
The recently published application, regarding scapular dyskinesis, is a microcosm that illustrates an important dialogue about how today’s therapists need to see chronicity as a multi-system interaction that requires multisystem treatments. Walker et al. used ES in a novel way to address scapular dyskinesis.
5 The recently published application, regarding scapular dyskinesis, is a microcosm that illustrates an important dialogue about how today’s therapists need to see chronicity as a multi-system interaction that requires multisystem treatments. Walker et al. used ES in a novel way to address scapular dyskinesis [ , Iniguez RO, Trueblood PR*, Tracz S and Zarrinkhameh L
Background: Medications are one identifiable risk factor for falls. In addition to polypharmacy, certain medications have been associated with an increased risk for falls. The purpose of this study is to assess if the most frequently prescribed medication categories: psychotropic, opioid and cardiovascular are associated with an increased incidence of falls in community dwelling adults 65 years and older. Methods: This retrospective observational study used data collected from subjects who participated in the Senior Awareness and Fall Education Balance Screening Program throughout Fresno County from 2007-2014. A review was completed by one person to identify psychotropic, opioid, and cardiovascular medications. Due to the abundance of cardiovascular medications, this group was classified into 12 subcategories. Participants were identified as a faller if they had experienced ≥2 falls in the last year and ≤1 fall served as the comparison group. Results: A total of 509 participants were included. A stepwise logistic regression analysis was used to examine the predictor of falls. The overall model was statistically significant (P<.001). Furthermore, 70.3% of fallers and non-fallers were categorized correctly when subjects were taking psychotropic and opioid medications. Chi-square test analysis detected a statistically significant association between reported incidence of falls and use of either psychotropic or opioid but not cardiovascular medication category. When cardiovascular drug classes were subcategorized, the use of antiarrhythmic medication was statically significant. The strongest predictor for falls, however, was use of psychotropic and opioid medications combined. Subjects taking at least one medication from psychotropic drug class were 2.4 times (OR 2.4, CI 1.56-3.64) more likely to have reported a fall. Those taking opioid medications were only 2.1 times (OR 2.1, CI 1.17-2.23) more likely to have reported a fall. But, if the subjects were taking medications from both psychotropic and opioid classifications, they were 4.3 times (OR 4.3, CI 1.96-9.64) more likely to report a fall.1Conclusion: Identification of older adults who consume anti-arrhythmic, opioids, or psychotropic medications could allow for patient education on adverse drug reactions, early intervention of fall prevention, or referral to physician/pharmacist for medication consolidation, in line with new national initiative for decreased opioid use.
6 Validation of the Gujarati and Hindi Versions of Modified Falls Efficacy Scale , Joshi S1* and Kumar GP2
Background: Frail, old patients with and without cognitive impairment are at high risk of falls and associated medical and psychosocial issues. The Modified Falls Efficacy Scale (MFES) was developed to assess fear of falling and it is shown to be a reliable and valid measure of falls self-efficacy in western countries. The lack of adequate, validated instruments has partly hindered research in this field. Methodology: The ‘forward-backward’ translation procedure was applied to translate the MFES into Hindi and Gujarati. Harmonization was done by expert panel review and pilot testing over 10 subjects. The questionnaires were then finalized.98 participants (70-Gujarati MFES; 28-Hindi MFES), meeting inclusion-exclusion criteria and willing to participate were included in the study. Interview regarding general health and fall history was taken. Gujarati MFES and Hindi MFES data were collected and Berg Balance Scale was performed. Results: The analysis of internal validity of the Gujarati and Hindi MFES revealed that the scale items presented adequate internal consistency (Cronbach’s alpha: Gujarati MFES- 0.993, Hindi MFES-0.992).The Gujarati MFES showed strong positive correlation with BBS (r=0.820, P value=0.000) and a strong negative correlation with age (r= -0.351, P value=0.003). The Hindi MFES showed a moderate positive correlation with BBS (r=0.565, P value=0.002) and a weak negative correlation with age (r= -0.297, P value= 0.125). Conclusion: The Gujarati version of MFES is a valid and measure to estimate fall-related efficacy in older adults who have Gujarati as their first language. The Hindi version of MFES shall have its validity established with a larger sample size.
7 An Observational Study to Determine and Compare Effects of Various Physical Test Components on BMI of School Going Children , Jhaveri B* and Savaliya G
Purpose: To evaluate and compare the physical fitness components in relation to Body Mass Index of school going children. Study design: Across-sectional observational study. Methods: 100 school going children of 8th and 9th grade were selected to serve as subject for this study. Children were divided into three groups by calculating BMI as per the height and weight of each child, I.e. Low BMI (N=35), Middle BMI (N=35) and High BMI (N=30) groups, which were compared with each other. All the subjects were tested on Curl-up test, Shuttle run test, Sit & Reach test and BMI (Body Mass Index). In order to find out the significance of differences between the three BMI groups of children, mean, standard deviation and p-value were computed. Results: The results of the study revealed significant differences (p<0.05) between Low BMI and High BMI groups in their Curl-up test, Shuttle run test and Sit & Reach test. Conclusion: low BMI group children were found to be better in muscular strength, flexibility and endurance level compared to middle BMI group & high BMI group children.
8 A Comparative Study of Postural Stability in Subject with Hallux Valgus and Flat Feet: A Cross-Sectional Study , Rathod HP*, Katherawala S Memon A and Lakhani N
Background: Hallux valgus (HV) and Flat Foot (FF) are common conditions, affecting adults between 18-25 years of age. Today’s styles of women’s footwear encompass two key design features, an elevated heel and a constrictive toe box. Shoes with a narrow toe box increase pressures on the medial side of the foot and between the toes. Early shoe wearing in children impairs the development of longitudinal arches. Over time, these changes may contribute to the development of foot pain and deformity and may affect postural stability. Aim and Objective: To assess and compare postural stability in subjects with Hallux Valgus and flat feet by using sense move. Materials and Methods: Total 40 females were assessed and compared postural stability by using sense move. In which Group A included those with Hallux Valgus (N=20) and Group B included those with Flat foot deformity (N=20). Postural Stability was assessed and compared in centre and off-centre directions. Unpaired t-test was carried out for analysis of outcomes. Results: The result of the study is, the Front and Back direction of postural stability in subject with Flat foot is more affected compared to the subject with hallux valgus and right and left side of postural stability in subject with hallux valgus is more affected compared to the subject with the Flat Foot. Conclusion: The study concludes that the subjects with the hallux valgus were showing more affected postural stability in mediolateral (Left and Right) direction compare to subjects with FF, subjects with the Flat foot were showing more postural stability affected in Anteroposterior (Front and Back) direction Compare to subjects with HV.
9 Health Literacy: Pure and Simple , Koenig VE*
Policy priorities and growing evidence indicates occupational and physical therapists need to consider their clients’ levels of health literacy if they are to provide effective, client-centered treatment
10 Effects of Ischemic Pressure Vesus Acupuncture Stimulation on Myofascial Neck Trigger Points , Abdel Hady AHM, Balbaa AA, Elazizi H, Rehan AM, Elkozamy H and Abdalbary SA*
Neck pain is a common complaint that may contribute to substantial medical consumption and disability. The aim of this study was to investigate the effects of ischemic compression therapy and acupuncture stimulation on myofascial neck trigger points Methods: 30 patients with myofascial neck trigger point were randomly assigned into group-A received ischemic compression treatment (ICT) on upper fibers of trapezius muscle and group-B received acupuncture point stimulation (dry needling) for upper fibers of trapezius muscle. In group (A) the (ICT) was applied three sessions a week for, while in group (B) the (dry needling) was applied three sessions a week. Results: Pain pressure tolerability (PPT) (evaluated by Pressure Algometer), neck pain and function were evaluated by neck disability (NDI), cervical range of motions (CROMs) were evaluated by Digital Water Level, isometric muscle strength by hand held dynamometer and evaluation of trigger points by ultrasonic before and immediately after the treatment and one week after the study. At the end of the study; both groups showed a significant improvement (P-value <0.05) in all evaluated measures except in muscle strength there was no improvement, there was no significant difference between both groups at pre and post treatment (p>0.05). Conclusion: Dry needling is significantly more effective than ischemic compression in improving pain pressure threshold, neck pain and disability, and Cervical ROMs in patients with CMNP.
11 Double Crush Syndrome - Features of Etiology, Pathogenesis and Clinical Course , Vladeva E*
Although carpal tunnel syndrome (CTS) is a diagnosis, which has been known and treated for more than 50 years, nowadays this is a pathology with considerable influence over the quality of life of a large number of patients, having important socio-economic consequences for society. This is a suffering where the pain and the impaired sensation in the palm and wrist area are often accompanied by problems engaging the entire upper limb. Double crush syndrome results from the compression of the same peripheral nerve at two or more levels, which is the cause of a synergistic enhancement of compression-related symptoms. Very often, this syndrome may cause a "blurring" of the clinical picture, which may occur with less typical clinical symptoms, as well as cause insufficient satisfactory results both in the conservative and the operative treatment of CTS. The article is an overview of a number of reports concerning aetiology, pathogenesis, demographic characteristics, and some controversies about epidemiology, risk factors, and pathophysiology of double crush syndrome. The clinical manifestations of the syndrome, as well as the possibilities for functional and instrumental diagnosis are discussed. The uniqueness of the pathology and the symptoms of compression of median nerve at several levels suggest treatment should be conservative at first. Differentiation of double crush syndrome is of particular importance in the therapeutic approach. Although the question of a complete understanding of double crush syndrome remains incomplete, this is a real phenomenon that the therapists of different specialties should consider not only in the case of suspicion of proximal and distal compression of median nerve, but also in some systemic diseases and polyneuropathies. Exact history, correct interpretation of the results of the clinical study, selection of a suitable instrumental diagnostic test are a pledge to find the right approach in its treatment optimally satisfying the patient and the therapist with the outcome of therapy.
12 Comparison of Autonomic Nervous System Activity in Subjects with Chronic Neck Pain and Healthy Controls , Sillevis R* and Cleland J 
Objective: This study investigated if differences in autonomic nervous system activity exist in patients with chronic neck pain as compared to controls measured by using a fully automated pupillometry system. Methods: 100 chronic neck pain subjects and 50 controls participated in this quasi-experimental study design evaluating the effect of chronic pain on the autonomic nervous system using a fully automated method of pupillometry. The Chisquare test for categorical data was used to establish homogeneity of baseline characteristics. The Mann-Whitney U test determined the difference in pupil diameter between the chronic neck pain group and the healthy control group. The Spearman’s rho test was used to relate the pupil diameter to the Neck Disability Index (NDI) scores, subject’s age, and the duration of chronic neck pain. Results: This study demonstrated that the chronic neck pain group had a statistically significant smaller pupil diameter than the healthy control group (p=0.022). This study showed that there was no relationship between the NDI scores and the pupil diameter change. However, there was a weak to moderate correlation between age and pupil size (p<0.001), indicating that there is a significant negative relationship and that the pupil diameter decreases with age. There was a weak but non-significant correlation between the pupil diameter and the duration of chronic neck pain (p>0.05). Discussion: The results of this study demonstrate that subjects with chronic neck pain exhibited a smaller pupil diameter than healthy controls. This is a direct indication of an altered autonomic balance.
13 A Study to Find out Con-Current Validity and Reliability of Mini-Balance Evaluation System Test for Assessment of Dynamic Balance in Post Stroke Patients – An Observational Study , Desai B* and Padnani R
Background: Stroke or brain attack is a sudden loss of neurological function caused by an interruption of the blood flow to the brain. Balance control is a fundamental motor behaviour in stance phase of gait that allows an individual to maintain and adopt various postures, react to external perturbances, and use automaticpostural responses that precede voluntary movements. So purpose this study was designed to find out reliability and concurrent validity of Mini-BESTest for assessment of dynamic balance in post stroke patients. Objective: To find out concurrent validity and reliability of Mini-BESTest for assessment of dynamic balance in post stroke patients. Methodology: An observational study consisted of 32 post stroke patients, both male and female with age group between 30-65 years. Written consent was taken who fulfilled the selection criteria and were willing to participate in the study. After explaining whole procedure, the patients were assessed using Mini-BESTest by two rater for inter-rater reliability and by same rater at different time (24 hours of duration) for test intra-rater reliability. The patients were also assessed by Berg Balance Scale (BBS) to find out concurrent validity of Mini-BESTest. Results: Results was analysed by using SPSS 20 version for windows software. Intra-rater and inter-rater reliability of Mini-Balance Evaluation System Test were assessed by Spearman's correlation coefficient (rs). Mini-Balance Evaluation System Test and Berg Balance Scale were assessed by Spearman’s correlation coefficient. Spearman correlationcoefficient (rs) for intra rater reliability is .862 with p < 0.05 and for inter rater reliability rs = .774 with p < 0.05. Spearman correlation coefficient (rs) between Mini-BESTest and BBS is 0.537 with p < 0.05 respectively. Conclusion: As a clinical test, Mini-BESTest is reliable and valid tool to use in post stroke patients for assessment of dynamic balance, easy to score, quick to administer (5-10 min), requires little space. Also rehabilitation can be planned according to component of score
14 Pilot Testing of Assessment of Capacity for Myoelectric Control (ACMC) in Evaluating Myoelectric Hand Function in Chinese Population , Lai FH*, Yan EW, Ma BT, Zhao ZG and Liu T
Upper limb amputations cause marked functional disability and lower the individual’s self-body image, with severe psychological implications. Many rehabilitation parameters are involved in the successful rehabilitation of upper limb amputations. The aim of this study was to examine the validity and reliability of the Chinese version of Assessment of Capacity for Myoelectric Control (Chinese-ACMC) in upper limb amputated subjects and with a myo-electric-powered prosthetic hand. To validate the Chinese version of Assessment of Capacity for Myoelectric Control (Chinese-ACMC) in upper limb amputee subjects (children and adults) with a myo-electric-powered prosthetic hand. A sample of convenience sampling of 22 subjects (11 males, 11 females) with upper limb amputation and myoelectric prosthetic hands were recorded during a regular clinical visit for ACMC. Each subject was evaluated according to four criteria: (a) Upper Limb Amputation including all levels of amputation; (b) No specific pain type – no matter phantom or pain in the stump; (c) With intact cognitive function; (d) Age ranged from 12 to 40 years. With instruction, occupational therapists and prosthetic-orthotics with at least twenty years’ clinical experience of myoelectric prosthesis training would conduct the 30-items Chinese ACMC for each subject. A serial of errand tasks of activities of daily living were designed for evaluation. Individuals’ ratings were repeated after 4 weeks. Through test-retest reliability, internal consistency testing, factor analysis, intra and inter factor correlation analysis. A four-factor structure, namely, “Gripping”, “Holding”, “Releasing” and “Coordinating” are identified.
15 Differential Diagnostic Approaches in Traditional Chinese Medicine and Western Physiotherapy for Mental Illness and Psychosocial Disorders: Similarities and Challenges in Integrating and Promoting East-Meet-West Approaches - Mini Review , Wong HY and Law YM*
The improvement of accurate management of psychosocial disorders and mental illness are the raising concern in the field of rehabilitation profession in the recent decade. The combination of the features and values of traditional Chinese medicine (TCM) and western physiotherapy approaches has also been advocated worldwide. It remains unclear for the integration and implementation of TCM and western approaches for promoting more accurate diagnosis and management of mental illness and psychosocial disorders from a rehabilitation perspective. This article provides a minioverview about the similarities and challenges about eastern and western approaches for the rehabilitation needs of mental illness and psychosocial disorders in clinical practice. This may facilitate further discussion and improvement of combining the values of eastern and western healthcare concepts and methods for the benefits of the people with various psychosocial and mental health needs.
16 Importance of Trunk Stability in Preventing Knee and Ankle Injury in Soccer , Aswin E and Senthilkumar T*
A sports like football comes with an elevated risk of injury due to the nature of the game. It involves combination of high-intensity repetitive activities such as kicking, sprinting, and jumping. These activities are not only physically demanding on players but carry a potential bias toward the use of trunk and hip flexor muscles. Asymmetry or imbalance of muscle properties such as strength and flexibility are most common reasons behind injuries in football. Knee and ankle injuries are commonly seen in football
17 Motor and Nonmotor outcomes in a Yoga and Task Based Exercise Program: A Pilot Study , Rivera M*, Tan NA and Trueblood P
Background and Purpose: Parkinson’s disease (PD) is a progressive neurodegenerative disease characterized by motor, nonmotor, and functional deficits. Physical interventions shows promise in reducing motor deficits, however displays variable results in reducing nonmotor symptoms. It is well established that task based training improves balance and function in neurologic conditions, and yoga, a complementary exercise shows positive outcomes in mood and sleep. Instituting Yoga in conjunction with task based functional activity may provide a balanced intervention program to ameliorate key deficits. Therefore, the purpose of this pilot study is to ascertain whether Yoga coupled with task based exercise will induce positive change in function, postural alignment and control, improve quality of life, and reduce fatigue in persons with PD. Methods: Ten participants with PD (6 men and 4 women) with a mean age of 66.4 years enrolled in a two time per week, 8-week group intervention. The pilot study is a one group pre-post design. Outcome measures were the Cognitive Timed up and Go (TUG), Ten Meter Walk Test, craniovertebral angle for forward head, Fullerton Advanced Balance Scale (FAB) and Berg Balance Scale (BBS). The study examined the nonmotor domain by implementing the Parkinson’s disease Quality of Life (PDQL) and the Parkinson’s Fatigue Scale (PFS). Results: The PFS showed significant pre (median score 60) to post-intervention differences (median score 49), Z =-2.03, P=.042. The BBS revealed significant improvement from pre (median score 52) to post intervention (median score 53), Z=-2.108, P=.035. Additional findings were reductions in the mean craniovertebral angle (6 degrees), 4.3 second reduction in the Cognitive TUG and a mean gain of 9 points in the PDQL. Discussion and Conclusions: A positive outcome was the reduction in fatigue, which was present throughout the Hoehn and Yahr stages. Furthermore, advances were noted in cervical alignment, postural control (BBS) and the Cognitive TUG. Yoga coupled with task based activity shows benefit in reducing fatigue and improving postural control in individuals with PD. Future studies should combine Yoga and functional activities to ascertain additional benefits.
18 Effects of Antipronation Taping on Single-Limb Stance Static Balance in Subjects with Pronated Foot-an Experimental Study , Vasanth S, Tilak M*, Samuel W, Babu A and Thomas R
Aim of the Study: To investigate the effect of antipronation taping on subjects with pronated foot during single limb stance. Background: Abnormal foot pronation causes passive instability of the joints of foot. The pronated foot, therefore, is unstable during weight bearing. The effect of antipronation taping on pronated foot during single limb stance lacks evidence. Study Design: Single-group repeated measures design. Methodology: Ten subjects (3 men, 7 women) with pronated foot (navicular drop = 13.0 ± 3.7mm) participated in this study conducted at the Mary Varghese Institute of Rehabilitation, Christian Medical College, Vellore. The subjects were asked to stand in unilateral stance on the dominant leg on the force platform of the balance master for 10 seconds. The degree of sway in the anteroposterior (AP) axis, the transverse axis and the velocity of moment (mm2/s) were calculated before and after application of antipronation taping. A mean of three recordings was taken for analysis. Results: There was a significant reduction in the scores of velocity of moment, anteroposterior sway and mediolateral sway after taping of the pronated foot. (P-value = 0.005) Conclusion: The study shows that antipronation taping improves single limb stance balance in subjects with pronated foot.
19 Observed Behaviors of a Child while using an Adapted Ride-on Car: A Case Study , Plummer T*
There is a dearth of literature on the use of augmented mobility with infants and young children. However, there have been several studies that indicate that the use of a modified ride-on-toy enriches a child’s access to the environment. A few case studies have been done with children with cerebral palsy, spinal muscular atrophy, spina bifida, or down syndrome, but no case study has been done with a child with Segawa Syndrome. This case study aims to add to the existing literature on the observed behavior of a child while using a modified ride-on toy. Data was collected through use of video recordings of 10 minutes of play on a mat, and 10 minutes of play in the modified ride-on toy, for 8 weeks. Data was collected every two weeks, coded by two researchers, and behavior frequencies were collected. During each session, the child’s performance was scored on a modified power mobility skills checklist. After 8 weeks of use of the modified ride-on car, the child’s score increased on the modified power mobility skills checklist, and had greater environmental interaction than before the study. Preliminary results indicate that a child with a mobility impairment can benefit from using a modified ride-on car and experience greater opportunities to engage in their environment.
20 Effectiveness of Shortwave Diathermy in Persons with Osteoarthritis of Knee Joint - an Experimental Study , Yarusha, Tilak M*, Samuel W, Samuel JD, Babu A, Thomas R and Rebekah G
Background and Objectives: Knee osteoarthritis (OA) is a painful condition affecting 85% of population with radiologically evident changes in subjects above 65 years of age, causing disability and muscle weakness. Shortwave diathermy (SWD) is a deep heating modality which has been extensively used to alleviate pain in persons with OA knees. However the problem of non-adherence to this modality remains a challenge and a persistent problem because of long treatment period, as a result of which, substantial numbers of patients do not get the maximum benefit, leading to poor health outcomes. Therefore the purpose of this study was to find out if shorter periods of shortwave diathermy in persons with knee osteoarthritis improve outcomes and compliance to therapy. Design: Quasi experimental pre-test post- test study. Methodology: A total of 15 subjects with OA knee, mean age of 57.4 ± 5 years consented to participate in this study after a written consent. The baseline assessment was performed using Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Elderly Mobility Scale (EMS) for assessing pain, activity and mobility status respectively. After 5 days of SWD and Quadriceps strengthening exercises, a final assessment was done to document the change in VAS, WOMAC and EMS. This data was analyzed to find out if outcomes improved with short period of SWD. The number of drop outs was also analyzed to report the patient compliance to therapy. Results: The results from this study shows significant reduction in pain using VAS (p value =0.003), improvement in WOMAC scores (p value =0.002) and EMS (p value =0.033), following 5 days of SWD. The dropout rate due to noncompliance was 6.5%. Conclusion: There was significant reduction in pain, and improvement in activity level and mobility status following short period of SWD in subjects with OA knees with a low drop out percentage.
21 Diclofenac Sodium Iontophoresis Enhances Quality of Sleep in People with Knee Osteoarthritis , Aiyejusunle CB*, Akinbo SRA and Faminu JA
Background and Objectives: Osteoarthritis (OA) is a common cause of physical and psychosocial disabilities in people characterised by pain and joint dysfunctions which hinder their daily and social activities as well as quality of sleep. Iontophoresis, involving the transference of drugs transdermally, is one of the novel therapeutic modalities for managing OA .The objective of this study was to determine the effect of diclofenac sodium iontophoresis on quality of sleep in people with knee osteoarthritis. Method: Twenty (20) participants (5 males, 15 females; mean age 55 years) with knee OA were recruited for this study. The participants were randomly assigned into two groups. Group A was treated with diclofenac sodium iontophoresis in addition to exercises. Group B, the control group, received only exercises. Each group was treated for duration of 4 weeks, comprising 2 treatment sessions per week. The Medical Outcome Study (MOS) Sleep Scale was used to assess quality of sleep, respectively. Result: Significant improvement occurred in both groups post-treatment (experimental group p= 0.004 respectively. Control group: p= 0.001). However, ION group had more improvement (p= 0.02) in quality of sleep when compared to CTRL group. Conclusion: This study revealed that there is a significant improvement in quality of sleep in people with osteoarthritis when treated with diclofenac sodium iontophoresis.
22 Exercise and Lymphedema in Context Cancer Rehabilitation. A Historical Review , Johansson K*, Johnsson A and Jonsson C
The historical review is based on key articles and systematic reviews including meta-analysis during the last decades and describes he development preceding the paradigm shift that has taken place in cancer rehabilitation, in particular in exercise and lymphedema. Cancer survivors were for long recommended to live a sedentary life as it was believed that vigorous exercise might provoke development of lymphedema. However, in the 1990ies it was found that the cancer survival rate was dependent on exercise level, and since then it has been proven, in breast cancer patients, that vigorous exercises is safe both for cancer survivors at risk of developing upper limb lymphedema and for those who already have one. Further research is needed for lower limb lymphedema, but there is reason to believe that exercise for these patients can be performed with similar protocol.2
23 Towards a Structured Collaborative Clinical Decision Making , Aiyejusunle CB*
Philosophies, scientific theories and personal experiences have provided us in the healthcare sector with models on which interventions are based. Unfortunately, they have not taken us, care providers and care recipients, as well as stakeholders to our desirable goal of achieving quality healthcare delivery which is satisfying to all. What is lacking therefore requires more rigorous attention to the details of our practice.
24 Coach’s Eye a Tool to Evaluate Kinematic Variation during Weight Acceptance Phase among Community Stair Climbing Population , Dubey RS* and Thajudeen A
Subtle signs of musculoskeletal diseases are likely to be discovered earlier in task involving walking up the stairs. Stair walking monitoring in daily living environments is what is needed to screen people for clinical treatment. Tools are being developed for modeling digital humans within virtual environments to facilitate designing products, evaluating capabilities, predicting injuries in real-world scenarios. Coach’s eye is one of the most effective tool to provide meaningful feedback to the patients, so they can make rapid improvements and also helps quickly improve overall patient performance by providing instant video feedback. Purpose: (i) To measure kinematic knee ROM using coach’s eye feedback tool, (ii) To identify the normal tread depth and riser height in relation to normal kinematics. Methodology: A group of 30 subjects including male and female having knee pain with the mean age 41.75 (±5.784) were analyzed. The groups underwent kinematic analysis while climbing up the stairs by step over step pattern in their own storey buildings. Videos were obtained in the sagittal plane by the video recorder utilizing the coach’s eye feedback tool. The level of pain was measured using visual analogue scale. Reflective markers were attached on right & left upper iliac crest, lateral femoral condyle & lateral malleolus for effortless measurement of knee joint angle.
25 The Role of the Occupational Therapist in Chronic HIV Management , Armstead A*
A diagnosis of human immunodeficiency virus (HIV) is no longer a death sentence. For more than a decade, the new cases of HIV remain steady in the United States (US); however, HIV rates among those who identify as Black/African Americans, Latinos, and men who have sex with men are increasing.
26 The Physical Impact of Spina Bifida in an Irish Population , Culligan E, Governey S* and Leonard J 
The aim of this study is to review the physical needs experienced by children with spina bifida (0-18 years) in Ireland. Ireland has one of the highest rates of Neural Tube Defects (NTDs) in the world and is therefore an ideal population to study. 155 parents/guardians completed purposively designed quantitative questionnaires. Results were analyzed using descriptive statistics including frequency distributions, measures of central tendency using excel; and bivariate relationships using SPSS. Physical presentation of this complex condition impacts on many aspects of children’s lives. The most prevalent level of spinal lesion was lumbar (27%) followed by lumbosacral (19%) and sacral (12%). 64% of children have a Cerebrospinal Fluid (CSF) shunt in situ. 69% of children required a wheelchair for mobility. Orthopaedic complications are high at 78%, increasing to 90% >10 years. 84% of all children required interventions to support their continence and urological health which increased to 93% for school aged children. Nearly all body systems are affected and require support. Although the underlying disability is present from birth, the implications and secondary complications of SB can be significant. What this paper adds • Physical impact of Spina Bifida in the Irish Population • Orthopaedic complications and surgery rate 90% in over 10 years • Bladder / Bowel incontinence present in over 85% of population
27 The Effect of Footwear on Postural Sway in Community Dwelling Older Adults , Goehring M*, Kristin Cekander, James Clark and Laura Subject
Background and Purpose: Non-slip socks are frequently used in health care settings in an attempt to reduce falls. Increased velocity of postural sway has been shown to relate to increased risk of falling. The influence of footwear on velocity of postural sway has yet to be determined. The purpose of this study was to compare the velocity of postural sway of community-dwelling older adults during a simulated fall while barefoot, wearing athletic type shoes, or wearing non-slip socks. Methods: Postural sway was measured during a simulated fall on 27 ambulatory adults with an average age of 58.07 years using computerized posturography. Subjects underwent three simulated falls in each footwear condition (barefoot, shoes, non-slip socks). Thirteen of the 27 subjects completed a post-study survey to subjectively rank the stability of each footwear condition. Hierarchical linear modeling statistics determined the difference in velocity of sway wearing different types of randomly applied footwear with P≤.05. Results and Discussion: In static standing, the mean velocity of postural sway for barefoot and non-slip socks was 0.26 m/s, athletic shoes was 0.31 m/s; barefoot and non-slip socks demonstrated lower velocity of sway at p-value of P<0.05 when compared to athletic shoes. In dynamic standing during the simulated fall, the mean velocity of postural sway for barefoot was 2.57m/s, athletic shoes was 2.66m/s and non-slip socks was 2.38m/s. Non-slip socks demonstrated lowest velocity of sway at p-value of P<0.001 when compared to athletic shoes. Post-study survey analysis revealed a p-value of 1.000. The p-value of 1.000 for the post study surveys concludes that the subjective rank of the most stable footwear condition did not match objective data. This indicates subjects were unable to subjectively determine which footwear most reduced postural sway. Conclusions: Non-slip socks may be effective at reducing the velocity of postural sway in community-dwelling older adults and may be effective at reducing fall risk
28 Prevalence of Musculoskeletal Injuries in Kho-Kho Players , Patil D*, Dua R and Pandit U
Background: Kho-Kho, a popular sport in India, is a game of fitness, timing, reflex and stamina. This game involves rapid and forceful movements of the body as a whole with quick reflexes resulting in frequent injuries. These injuries result from accidents, poor training practices, inadequate facilities, lack of conditioning, or insufficient warm-up and stretching. It is necessary to understand the injury prevalence, so as to identify risk factors and to set up preventive measures. Objective: To determine the prevalence and nature of injuries in school and college going Kho-Kho players. Methods: Injuries in school and college going Kho-Kho players for past one year were assessed with the help of the questionnaire. Results: There was a higher prevalence of injuries (83.4%) in these young athletes. The time loss due to muscle and ligament injury was 1-3 weeks. Conclusion: A high prevalence of injuries was noted in school and college going kho-kho players in the past one year. Lower limb injuries were more common. The knee, ankle & foot and wrist & hand were the most commonly injured sites
29 The Long-Term Effects of Eccentric Exercise Vs. Extracorporeal Shockwave Therapy in Athletes Aged 18-50 with Lower Extremity Tendinopathy: A Meta-Analysis and Systematic Review , Hickey CJ*, Walker D, Lee SJ and Vitato N
Background: Establishing the most effective treatments for patellar tendinopathy (PaT) is critical because of its high prevalence in as an orthopedic condition, particularly in jumping athletes. Two increasingly popular and researched therapy interventions are extracorporeal shockwave therapy (ESWT) and eccentric exercise (EE). Yet it has not been established how the two compare to each other. Objective: The purpose of this study was to compare via meta-analysis the long-term effects of EE on both pain and function to those of ESWT in athletes with PaT and to also compare with a systematic review the same PICO components with the addition of Achilles Tendonopathy (AT). Data Sources: Search procedures followed PRISA guidelines using the PubMed, CINAHL, and Cochrane Library databases. Study Selection: Athletes ages 18-50 years, PaT for >3 months, EE, ESWT, Visual Analog Scale (VAS) measuring pain, Victorian Institute of Sport Australia – Patella (VISA-P) measuring function. Results: A fixed effects model was used to compare the interventions. Eccentric Exercise was found to have very large effect sizes of 2.363 (1.075, 3.651) and 18.790 (8.604, 28.977) for improving pain and function respectively when compared with extracorporeal shockwave therapy. Conclusion: Eccentric exercise is the treatment of choice for athletes with patellar tendinopathy, while extracorporeal shockwave therapy is a viable secondary option for patients that fail to respond to eccentrics alone.
30 School and Sleep Participation of University Students , Delos Reyes RC*, Ababao AML, Cabatay AGA, Fernandez SMD, Homoroc ZCV and Luna SMA
Occupational therapists deemed that restful and adequate sleep is an essential factor that affects occupational performance, participation and engagement in daily life because sleep influences many body functions such as cognition that aids an individual to function optimally. In order to achieve the beneficial effects of sleep, literatures suggest the right number of hours of sleep that individuals should obtain which is seven hours of night sleep and eight to nine hours of daily sleep. This study aimed to determine whether there’s a correlation between sleep participation which includes the number of hours of sleep and school participation of allied medical students in terms of their grade point average. Descriptive correlational research design was used to achieve the aim of the study. The subjects were chosen via convenient sampling wherein questionnaires were distributed upon the approval of the department chair of Occupational Therapy of University Batangas. The study found out that the average number of hours of sleep of the students was not tied with their grade point average. This study also revealed that majority of the respondents, which constituted 57.5% sleep for only 6 hours. Although the relationship between number of hours of sleep and grade point average were inconclusive, it is still alarming that most of the students were not able to get the recommended amount of sleep. There is a possibility that number of hours of sleep can affect other areas of occupation, not necessarily the student’s school participation.
31 Attitudes, Beliefs and Behaviors Regarding Marijuana Use among Occupational Therapists in the United States , McCombie RP* and Magee L
Background/Objective: Legalization of marijuana for medical and/or recreational purposes has spurred significant debate among health care professionals in the United States, though research on their opinions and usage is limited. The purpose of this study was to survey one specific health care grouping, occupational therapists, and examine their attitudes, beliefs, and behaviors specific to marijuana use. Methods: Following IRB approval, a national random sample of 500 occupational therapists were postal mailed survey packets which included a cover letter and a multi-page questionnaire. Results: One hundred ninety-five surveys were returned. The majority reported marijuana use was legal in their state for medicinal but not for recreational purposes. Less than ten percent had ever used marijuana for medical reasons; however, two out of five reported they had used marijuana for recreational purposes, though typically not within the previous five years. Reasons for use included to get high and to be sociable. A majority agreed marijuana should be legalized in all states for medical purposes, but conceded this would lead to more people trying it and making it more accessible to minors. Discussion: Discussion addresses these results in relation to general population usage, national legalization trends, and reported health benefits and concerns.
32 Functional Aspects of Elderly Participants of Health Promotion Groups , Vargas DG, Vargas JC, Oliveira MR*, Foletto Pivetta HM and Carvalho De Miranda FA
Introduction: The elderly population is growing rapidly and within it health systems need to be prepared to provide care and quality of life for this population through health promotion. Therefore, it is necessary that professionals working in these systems, through health promotion groups, know how to reconnect the functionality and level of health of these elderly people to propose preventive treatments and resolutive treatments, avoiding functional deficits and loss of quality of life of the elderly. Objective: To evaluate the functionality and level of physical activity of elderly participants. Methods: 29 elderly patients were evaluated. They were assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Functional Independence Measure (FIM) and the International Physical Activity Questionnaire (IPAQ), which assess functional functionality, functional independence and physical activity level respectively. Results: The mean age was 70.4±7.5 years and the predominant gender was female with 89.95%. Analyzing the functionality, WHODAS showed a mean of 39.9±8.9 and the MIF 125.4±1.2. Regarding Self-perception of health, 48.3% of the elderly reported good and at activity level 75% were active. Conclusion: It was observed that the evaluated elderly were physically active because they participated in groups of health promotions and the development of actions that have as a presupposition the maintenance of the functionality are necessary to maintain the health of the elderly.
33 Optimal Wellness through Participation: The Importance of Partnerships Outside of the “Therapy” World , Bewernitz M*
When we think of the word “barrier” what comes to mind? Many immediately think of physical barriers like lack of wheelchair access, poor lighting, or limited transportation options. The framework of the International Classification of Functioning, Disability, and Health (ICF) provides a structure for rehabilitation professionals to address context as a component of our health.
34 Emotional Intelligence: Soft Skills Training Curriculum, an Educational Training for Healthcare Students for Increased Success during Clinical Rotations , Thomas J*, Adames S, Gonzales A, Milina E and Zhao G
Emotional intelligence (EI), or soft skills, is a set of skills including professionalism, effective communication skills, organizational skills, and responsivity to feedback. Research indicates that healthcare students entering their clinical rotations may lack these sets of skills The lack of soft skills during clinical experience can strain the student’s professional relationship with their clinical educators/instructors (supervisors) and may result in failure After a review of relevant literature, the purpose of this research project is to augment the evidence-based, soft skills training curriculum being developed at SUNY Downstate Medical Center Occupational Therapy Master’s Program through the production of three educational videos that incorporate the perspectives of clinical educators, alumni, and current students. The goal of the project is to increase students’ knowledge of emotional intelligence and inspire self-awareness and reflection on their own professionalism. The curriculum would ideally function to increase students’ success during clinical rotations and develop more competent clinicians. The curriculum was piloted with second year occupational therapy students prior to their clinical rotations. The curriculum educated students on soft skills and promoted reflection on their own professionalism. The curriculum findings demonstrated significant outcomes with students reporting the use of emotional intelligence skills during clinical rotations to be valuable. The findings of this study indicate that the need for emotional intelligence training may also be applicable and valuable to students in various healthcare programs.
35 Program Implementation of Occupational Therapy Group Interventions for Women with Addictions , Hill K* and Johnson B
Objective: To determine if occupational therapy group services were beneficial for women in an entry-level addiction recovery center by utilizing a comprehensive post intervention survey. Methods: Female residents enrolled in the entry phase of a long-term addiction center participated in occupational therapy (OT) group sessions led by OTA and MOT students from the University of Louisiana Monroe. At the end of the semester, participants of the group sessions autonomously completed a 5-point Likert scale survey of 10-statements to rate the potential benefits of the occupational therapy interventions. This quantitative study investigated survey results in a two-year period supervised and directed by the two authors. Results: The survey results proved that OT is beneficial and needed in addiction rehabilitation for women with substance abuse. Conclusion: This academic-based program displayed the importance of implementing occupational therapy group interventions for women with addictions to enhance meaningful daily activities. Peer-reviewed articles that directly addressed known occupational performance issues and limiting factors commonly found within this population were facilitated through evidenced-based group sessions. The 5-point Likert instrument used in this quantitative study revealed powerful findings supporting the benefits of occupational therapy intervention in the recovery process.
36 Role of HIIT VS High Intensity Cardio in Fat Reduction , Yaseen A*
WHO entitled overweight and obesity as an inappropriate and extra accretion of fats in the body that can displays a hazard to wellbeing. A crude proportion of obesity is BMI (weight(kg)/ height(m2). A person having BMI>30 is typically consider as obese and person BMI≤25 is labeled as overweight.
37 Study on Dependency Levels in the Oncological Patient with Respiratory Symptomatology , Fernandez Rodrigue EJ* and Sanchez Gomez C
The incidence of cancer in Spain is increasing (annually 247,771 new cases diagnosed). Survival of oncological patients at 5 years of 53%. Main problem, the quality of that survival. Important conditioning factor, the levels of dependence of oncological patients in active treatment. The main objective was to evaluate the level of dependence of oncological patients with dyspnea. Methodology: Cross-sectional prospective observational study with non-probabilistic sampling of accidental allocation. The sample was recruited from the Medical Oncology Service of the University Hospital of Salamanca (CAUSA). We proceeded to refer patients to the occupational therapy program with the consequent inclusion of these in the study. After obtaining the informed consent signed by the subjects, the evaluation was proceeded. The Lawton-Brody scale (AIVD), and the Barthel index (ABVD). In addition, a record sheet for sociodemographic and clinical (age, gender and anatomopathological diagnosis) was designed. Results: Study includes the sample size of 180 participants.. Average age of 68.48 (± 10,513) years, of which 52.8% men, by 47.2% women (85 women and 95 men). Of which 22.8% had breast diagnosis, 31.7% pulmonary and 45.6% related to the digestive system. Regarding dependence levels, Lawton-Brody scale, mean score of 4.31 (± 1.832) points (moderate dependency levels); Barthel index, mean score of 42.53 (± 2,789) points (moderate dependency level). Poor scores in lung anatomopathological diagnosis. Strong and statistically significant correlation between ABVD and AIVD (r = 0.803, for p <0.05), and significant correlation (r = -0.403, for p <0.001) between age and the performance of IADL. Conclusion: Oncological patients with respiratory symptoms present moderate levels of dependence
38 To Compare the Effectiveness of Active Stretching and Eccentric Training on Hamstrings Spasticity in Spastic Cerebral Palsy Children , Zareen Shaikh S*, Palekar TJ and Basu S
Objective: To compare the effectiveness of Active-Stretching and Eccentric Training on Hamstrings spasticity in spastic cerebral palsy children. Design: Experimental Study Participants: 30 patients with cerebral palsy in the age group of 4-18 years (Modified Ashworth Scale till Grade 2) participated in this study. Intervention: All the patients were randomly selected from the OPD of Physiotherapy clinic after signing of consent form they were given 1 week rehabilitation protocol of Active Stretching(Group A) and Eccentric Strengthening(Group B). Modified Tardieu Scale, Popliteal Angle and GMFM Score were used to assess the spasticity. Main outcome measures: Modified Tardieu Scale, Popliteal Angle and GMFM Score. Result: On Day 1 and Day 7 Modified Tardieu Scale (MTS) was administered for Hamstrings, GMFM score -D (STANDING) was taken and Popliteal Angle was measured. To compare the values of MTS, GMFM and Popliteal angle at the end of 1 week in each group, repeated measure ANOVA was used. Further multivariate test was used to see the measure of strength of association and level of significance in each group. Conclusion: This study concludes that Eccentric Training has better improvement of Modified Tardieu Scale (MTS), GMFM Score and Popliteal Angle, over Active Stretching in reducing the Hamstrings muscle spasticity over a 1 week training program. Hence this study accepts the hypothesis that “Eccentric training is more effective than Active Stretching on Hamstrings spasticity in spastic cerebral palsy.
39 MIP and MEP Changed by Acupuncture Techniques in Costal , Morais Sanchez EG, Silva DO and Sanchez HM*
The respiratory tract is of great importance due to integrated functions of various systems, which allow gas exchange and the arrival of oxygen to the muscles. The aim of this study was to evaluate the respiratory pressure after acupuncture technique in the rib cage. Was a randomized study with 20 volunteers, age 18-25 years, divided into two groups 10 men and 10 women. The two groups were subjected to evaluation of the manometer respiratory pressures which were taken before and after treatment, physical therapy, which was used in costal acupuncture in one session of 10 minutes, during this time were made movements of rotation of the needle 5 in first minutes after application, the fifth and tenth minutes minutes after application, and then the needle was withdrawn the patient returned to the starting position, sitting where the measures were repeated maximal respiratory pressures. The values of maximal respiratory pressures (MIP and MEP) in men before and after the intervention period showed significant changes (p <0.05). In women, the values maximal respiratory pressures (MIP and MEP) showed statistically significant differences after the intervention period (p <0.05), comparing men and women MIP before and after the intervention period, no statistically significant , since the MEP before and there was no statistical significance after the intervention period was statistically significant in PE between men and women. Whereas p <0.05. The results of this study show statistically significant differences, since these were obtained due to the low number of patients this study can serve as props for other jobs.
40 Translating Research to Practice: Taking the Next Step to get Children Diagnosed with Cancer Moving , Daeggelmann J*, Wurz A, San Juan AF, Albinati N, Bloch W and Culos Reed SN2
Most research-based physical activity (PA) interventions show that children diagnosed with cancer experience healthrelated benefits during the intervention period. However, translating these interventions into practice is uncommon. To better understand if/how researchers translate their PA interventions to practice, we identified 65 researchers who had published research manuscripts/conference abstracts detailing PA interventions for children with cancer. Most authors reported their PA intervention was not translated into practice due to financing constraints and low adherence rates during the study period. Of those who did translate, strategies to overcome commonly cited barriers were provided. We can conclude that PA interventions are rarely translated to practice, as doing so is resource-intensive and requires concerted efforts from multiple stakeholders. Findings underscore the complicated nature of knowledge translation and raise questions about whose responsibility it is to move evidence to practice.
41 Еlectroneuromyographic Indices of Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease , Sadykova GA*, Aripov BS, Rakhmatullayev HU, Karimova GV and Аkhmedov MA
Elektroneuromyographic studies were carried out according to the amplitude and muscular response of respiratory muscles to electrical stimulation in 28 patients with chronic obstructive pulmonary disease of 2, 2-3, 3 severities at the age of 49 to 65 years. The revealed changes in the functional state of the respiratory muscles and the function of external respiration aggravate the progressive nature of the pathological process in the lungs in chronic obstructive pulmonary disease that requires timely prevention of respiratory failure and the choice of tactics of electrostimulation of respiratory muscles.
42 Best Practices for Oral Motor Stimulation to Improve Oral Feeding in Preterm Infants: A Systematic Review , Calk P*
Objective: Interventions within the scope of occupational therapy were examined to identify the effectiveness of prefeeding interventions toimprovefeedingoutcomesofprematureinfants.Evidence-based methods ofperi-oral and intra-oral stimulationandoral supportwereexploredandwillbediscussed inthis review. Method: Literature published from 1995 to 2015 using eight electronic databases and Cochrane Database of Systematic Reviews was searched. Fifteen studies met the inclusion criteria and were critically appraised and synthesized. Results: Analysis revealed bestpractices utilizing four areas of intervention: oral motor stimulation, non- nutritive sucking, oral support, andco-interventions. Conclusion: For infants, feeding is a vital occupation that supports growth and development. However, premature infants often have difficulties with the feeding process. Occupational therapists working with pre- term infants must have a sufficient understanding of the evidence to be able to employ best practices to improve pre-feeding readiness and oral feedings. Immature suck-swallow-breath coordination; absent, delayed, or impaired oral reflexes; abnormal muscle tone; and impaired motor control impact the infant’s safe and successful oral intake of adequate nutrition. Strong evidence supports theuse ofperi-oral and intra-oral stimulation forpre-feeding readiness andpreparation topromote successful oral feeding in preterm infants. There is also strong evidence to substantiate the use of oral support during feeding of preterm infants to increase suction and decrease liquid loss topromote efficient intake of nutrition.
43 Case Report about Morel-Lavella Lesions and Physiotherapy Management , Senthilkumar Thiyagarajan* and Ayyappan Amirtham
Road traffic accidents causing serious damages to the victims sometimes end up with the unknown clinical lesions. Poorly diagnosed condition may end up with serious complications. Morel-Lavallee lesions are rare medical lesion which damages superficial fascia and deep fascia. Post traumatic medical management for this lesion which gives complete recovery. Post operative physiotherapy for MLL was not given properly to these victims because of need of physiotherapy for this medical lesion was not well explored effectively to the physiotherapy professionals. In this study, sharing my clinical experience about MLL physiotherapy Management for the 30 years old male victim suffered from knee pain underwent MLL surgical procedure.
44 Treating Coccydynia Using Primal Reflex Release Technique TM Case Report , Carter C*
Background and Purpose: The hallmark presentation of coccydynia is localized pain over the coccyx. Patients typically report having tailbone pain; yet, the exact etiology of coccydynia is unknown. Factors such as obesity and female gender increase the risk of developing coccydynia with women being 5 times more likely to develop coccydynia than men. The purpose of this case report is to share the outcomes (results) of using Primal Reflex Release TechniqueTM (PRRTTM) to treat coccydynia. Method and Procedures: A 34-year-old Euro-American female patient presented to physical therapy with a complaint of recurrent, chronic tailbone pain with prolonged sitting on hard surfaces and surfaces with mild cushion.To determine the effects of the treatments, the patient was examined using the following tests and measures and outcome measurement tools: The 1 Minute NocioceptivExamTM, Two-Minute Walk Test (2MWT), Chair Sit and Reach Test (CSRT), the Numeric Pain Rating Scale (NPRS), the Modified Oswestry Low Back Pain Disability Questionnaire, and the Global Rating of Change (GRoC) Scale. Results: On discharge assessment (6th visit), the patient reported no (0/10) tenderness and pain during The 1 Minute NocioceptivExamTM with coccyx palpation and sidebending mobilizations. The PRRTTM coccyx release techniques decreased the patient’s worst coccyx pain to 1/10 with prolonged sitting after 1 hour on the NPRS at discharge versus 8/10 worst coccyx pain with prolonged sitting after 1 hour on the NPRS at initial examination. Discussion: The results support the effectiveness of using PRRT to treat coccyx pain. Using PRRTTM, an intervention model aimed at treating an up-regulated autonomic nervous system, may have contributed to the positive patient outcomes. Conclusion: The results showed that the PRRTTM paradigm’s coccyx release techniques can be effective in treating a case of coccydynia if not some or most cases. The results are not generalizable to all patients who may present to physical therapy with a complaint of coccyx pain including the male sex. Further research could include a large, diverse sample size.
45 Pain , Maria D*
Pain acts as a protective mechanism of the body, by forcing the person to react so that it is removed from the stimulus. It is important not only for cases where there is marked tissue damage, but also for everyday simple activities. Thus, when a person sits on the hips for a long time, it is possible to damage the tissues due to the inhibition of the skin’s blood supply to the places where the skin is compressed by body weight. When the skin starts to ache because of ischemia, the person completely unconsciously changes position. However, when the sensation of pain is lost, as is the case with spinal cord injury, the person cannot feel the pain and thus does not change position.
46 Intervention of the Occupational Therapist in the Oncological Patient with Cancer-Related Fatigue , Fernandez Rodriguez EJ* and Sanchez Gómez C
The occupational therapist as a health professional will carry out his intervention in all those patients who present a specific symptomatology or characteristics that require it. In the case of the cancer patient, which we are talking about, their intervention will not be based on directly attacking the neoplasm to prevent its development or to eliminate it, but will stick to acting as a member of the interdisciplinary work team, in charge of controlling secondary symptoms. To the oncological process, provide the necessary social support, both to patients and their caregivers, as well as to carry out actions that improve the quality of life of the individual.
47 Occupational Therapy and the Opioid Epidemic: Recognizing the Need to Address Mental Health Comorbidities in Resolving Opioid Substance Abuse , McCombie RP*
The incidence of opioid abuse internationally, and notably in the United States, has reached an admitted crisis level. While meaningful attempts have been made across all healthcare disciplines to address this tragedy, the primary emphasis within these attempts has been limited to the management and treatment of pain as an underlying causal agent. Unfortunately, attention toward the identification and treatment of associated mental health syndromes, specifically those acknowledged to have a concomitant connection with opioid abuse/addiction, has been severely lacking. Occupational Therapy, however, is one profession uniquely prepared to respond to this crisis through the acceptance of a co-morbidity treatment model stemming from its foundational roots in mental health, its contemporaneous philosophy, and its current treatment stratagems.
48 Application of Physical Factors in Complex Etiopathogenetic Therapy Patients with Coronavirus-19 , Dodtievich BV*
Fundamental scientific research of domestic and foreign scientists strongly suggests that the progress of medicine is impossible without the widespread use of modern physical factors in the diagnosis, prevention, treatment and rehabilitation of almost all nosological forms of diseases from newborns to old age of patients. Each micro-and macro-organism has individual bio energetic characteristics corresponding to its type, which is the main condition for normal life activity of the organism. In the case of “alien” bio energetic characteristics, specific biological processes inherent in this organism are disrupted, which leads to its death. The bio potential of each person is strictly individual in both normal and pathological conditions. The degree of deviation of the bio potential corresponds to the stage of development of the disease, i.e. the formation of intermediate States of the body with a violation of its supramolecular structures.
49 Effectiveness of Tailored Educational Resources for American Military Parents of a Child with a Disability: A Preliminary Study , Herman MB*
Background: This preliminary study attempted to address gaps and challenges military parents of a child with a disability experience. Through educational resource dissemination, the study hoped to increase caregiver knowledge of DIR, increase parent confidence for carryover of DIR, and increase satisfaction of OT services within a Pediatric Therapy clinic in Italy serving American military families. Methods: Five parents receiving services at a pediatric therapy clinic based in Italy participated in the pilot study. A pre and post survey was administered assessing parents’ satisfaction, knowledge, and confidence with the Developmental-Individual Difference and Relationship (DIR) Model before and after dissemination of educational resources. Wilcoxon signed-rank tests were performed to compare means of the change in satisfaction, knowledge, and confidence and means of the change in parent’s overall scores. Results: One parent demonstrated a clinically significant change in overall results from pre to post. There was not a statistically significant difference between pre and post for the group in satisfaction, knowledge, and confidence. Conclusions: This study was a preliminary attempt to further understand the experience of military parents of a child with a disability as well as increase availability of resources for this underserved and at-risk population. Findings suggest that tailored educational resources were slightly effective in increasing knowledge and provided insight into future research opportunities
50 Tailored Functional Activities for Self-Reported Barriers to Return-to-Work in Cancer Survivors: A Proof-of-Concept Study , Naomi Dolgoy PhD, Douglas P Gross, Chester Ho, S Nicole Culos-Reed and Margaret L McNeely*
Purpose: Working-aged cancer survivors (18-64 years) are on average 1.4 times more likely to be unemployed after completing cancer treatments than are similar aged healthy cohorts. Given the personal and financial burdens on working-aged cancer survivors, improving return-to-work outcomes is necessary. There is sparse cancer-specific research in work-related functional interventions with self-reported measurable outcomes. Research of cancer-specific exercise programs targeting stamina and endurance show promise in improving return-to-work, though these programs do not specifically address work-related activities. A foundation of successful work outcomes is self-efficacy, which has not yet been researched as a primary endpoint in cancer-specific studies examining work-related interventions. This pilot study explored 1. the feasibility of adding tailored work-related functional activities to a cancer-specific exercise program, and 2. the value of using the Canadian Occupational Performance Measure (COPM)’s productivity section as an outcome to measure performance and satisfaction as aspects of work self-efficacy. Methods: This study utilized a single group pre-test/post-test design with working-aged cancer survivors (n=7). Outcome measures included work-related physical performance (lift tests), participation (adherence to the program - attendance and participation logs), and work self-efficacy satisfaction and performance (the COPM).Results: All participants completed their functional interventions. 6/7 participants completed pre- and post-lift tests, showing improvements at the post-lifting assessment. Participant perception of goal attainment (performance and satisfaction) showed clinically meaningful improvement (2-point change) in all participants. Conclusion: This pilot study demonstrates the feasibility of using the COPM as a tool for measuring performance and satisfaction. Embedding work-related functional activities into a physical exercise program provides a model for potential implementation and scalability.
51 Comparative Study between Low-Level Laser Therapy VS. Therapeutic Ultrasound along with Exercises in Patients with OA Knee , Basu S, Deshpande MM*, Palekar TJ and Baxi G
Study Design: Pre-post experimental study design. Background: Degenerative changes around knee joint involve ligaments and cartilages. It is heterogeneous group of conditions that leads to joint symptom and signs associated with integrity of articular cartilages. Objectives: Present study was undertaken to add on to available treatment methods for osteoarthritis knee and to find out the effectiveness of laser therapy and ultrasound therapy for treating osteoarthritis knee. Procedure: In this study, 30 participants were recruited based on inclusion and exclusion criteria. Laser therapy and ultrasound therapy was administered to them for a period of 2 weeks, 5 sessions per week. Pre and post assessment were taken using following outcome measures- Range of Motion (ROM), Numerical Pain Rating Scale (NPRS). Result: There was significant decrease in NPRS in patients which is suggestive of quality of life. Also, Knee ROM was found to be significantly increases amongst these participants. The outcome of NPRS and knee ROM was statistically analysed. It was found to be effective with significant P value<0.000. Conclusion: Ultrasound therapy is an effective treatment and can be used for treatment of patients with OA knee.
52 Effects of High Iodine Containing Low Osmolar Contrast Agent (Visipaque) on Thyroid Function Tests , Niknamian S*
Objective: Investigating high iodine containing low osmolar contrast agent (visipaque) effects on thyroid function tests and thyroid sonography characteristics. Methods: 65 euthyroid cases and 92 controls composed the samples in baseline. Thyroid function tests, Urine Iodine Concentration (UIC) and thyroid sonography were conducted for both groups before and 1 and 3 months after angiography. Serum levels of T4, T3, T3RU, TSH, TPO-Ab and UIC were measured, and hypo/heyperthyroidism prevalence was compared between groups. Results: Mean T3, T4 and TSH changes 1 month after angiography were insignificant in both groups (P: 0.61, P: 0.4 and P: 0.14, P: 0.23 in cases and controls for T3 and T4). Medians among cases and controls were 12.8 and 16.75 µg/dl, respectively, at baseline. These values varied to 28.45 and 15.2µg/dl, and 12.95 and 14.2µg/dl 1 month and 3 months after angiography in case and control groups, respectively. UIC increase one month after angiography was significant among cases (P=0.002). TPOAb+ were same 3 months after angiography. Thyroid volume changes were significant among cases (P<0.001) and insignificant among controls (P=0.680). No significant difference was seen between cases and controls in overt hypothyroidism, however, a considerable change were seen in thyroid volume and UIC one month after angiography among cases. The hypothyroidism rate among cases was insignificant which may be either related to few cases or short half-life of visipaque (2.1 hour) so that 97% of injected dose was excreted in urine within 24 hours. Conclusion: Thyroid function test is not recommended before angiography in patients without previous thyroid records.
53 Common Occupational Therapeutic Interventions Adopted to Alleviate Lower Back Pain Produced by Persistent Sitting Posture , Moraba LM*, Ellapen TJ, Swanepoel, M, Strydom GL, Burger M, Hammill VH and Paul Y
Persistent-sitting-posture has been linked with vertebrae, shoulder, arm and leg work-related-musculoskeletal-complaints among computer-based office users. Work-related-musculoskeletal-disorders (WRMDs) affect the employee’s overall health, the company’s productivity and the nation’s economy. Numerous strategies have emerged to combat the ill-effects of persistent-occupational-sitting-posture, which inter alia include enhanced ergonomic workstations (sitting and standing), dynamic-sitting posture, active workstations (treadmill and cycle workstations), regular instructional prompting to take compulsory rest breaks and exercise therapy prescription. Ergonomic reconfigured workstations and exercise therapy has been most successful. This commentary reviews the aforementioned interventions. In South Africa, occupational health and safety is a collaborative inter professional effort of medical doctors, occupational nurses, occupational therapists and bio kinetics. An understanding of common international therapeutic interventions adopted to alleviate lower back pain produced by persistent-occupational-sitting-posture will strengthen their therapeutic strategies.
54 Efficacy of Modified Spray-Stretch Technique in Osteoarthritis Knee Associated with Pes Anserine Pain Syndrome on Pain, Flexibility and Balance , Swati Yadav*
Pes Anserine tendinopathies are also associated with Knee Osteoarthritis and may be cause of the knee pain. Unfortunately this is one of the most ignored causes of the knee which can be easily treatable. According to previous literature, there were around 183 cases were found to have Pes Anserine pain syndromes among 314 Osteoarthritis knees (i.e. 58.3%). Studies also available that Anserine bursitis was diagnosed clinically in 46.8% with O.A knee patients. According to clinical studies and less accessible assets, risk factors for Pes Anserine tendino- bursitis include female gender, overweight, raised blood sugar levels, knee osteoarthritis and knee structural abnormality. A static stretch lengthens a shortened muscle-tendon unit and connective tissues by the movement of a joint. Static stretching helps to increase muscle flexibility and joint range of motion. Muscle fibers, golgi tendon organs and other proprioceptors helps in maintaining balance and apprehension of position of body also called as proprioception. Spray and stretch is a technique which is performed by applying vapocoolant spray or analgesic spray to the pain region. Spray is applied in the parallel strokes.
55 A Comparative Study of Scapular Clock Excercises Vs Scapular PNF in the Treatment of Adhesive Capsulitis , Basu S and Oza S*
The aim of the study was to compare the effect of scapular clock exercises and scapular PNF techniques on pain and range of motion in the patients with adhesive capsulitis. In this study total 30 samples of Adhesive Capsulitis were screened according to the inclusion and exclusion criteria and were divided in two groups of 15 samples in each group respectively. Group A was treated with Scapular clock exercises whereas group B was treated with Scapular PNF techniques. Pretreatment and post treatment outcome measures were taken. Assessment was carried with the outcome measures Numerical pain rating scale (NPRS) for pain and a Universal Goniometer for Range of Motion. Subjects from both the groups were received treatment for 8 sessions a single session per day. The amount of change in the outcome measures were evaluated by the paired t test for comparing within the groups and t test was used to compare the results in between both the groups. The analysis of the study states, both the treatment groups shows significant reduction in pain, increase in Range of motion but Group B i.e. Scapular PNF group showed more significant improvement than Group A statistically. Study concluded that both Scapular Clock exercises and Scapular PNF techniques are effective on the pain and range of motion in Adhesive Capsulitis But Scapular PNF technique proved to be more effective than Scapular Clock exercises.
56 Visiting a Physiotherapist is Useful in the Early Phase of Low Back Pain , Karvonen E*
Background: The purpose was to examine physiotherapists’ (PTs) core competences in direct access practice for low back pain (LBP) in the early phase of pain using tissue-structural classification, and the implementation of this practice after a continuing education with clients’ and PTs’ experiences. Methods: Although previous research has shown direct access in physiotherapy to be an important method in preventing the recurrence of LBP, data are still lacking on the level of required competences of PTs, classifications of LBP and implementation of direct access practice after a continuing education program. Results: PTs’ core competences of clinical reasoning and critical reflection were on a good level when used tissue-structural classification and hypothetico-deductive method. PTs made accurate diagnostic subgroups for their LBP clients. The agreement between PTs and reviewers was 74% (kappa 0.63; 95% CI, 0.47 to 0.77). PTs also analyzed their clinical reasoning systematically from clients’ history to choices of clinical tests and conclusions. They justified their manual skills and the adequacy of the LBP classification in use and suggested other alternatives for their performance. 80% of the clients were satisfied with the implementation of direct access in the early visit to PTs and with the information and advice they received. Three months after the physiotherapy, repeat visits were on a low level and only one of the employed was on sick leave. PTs reported their work meaningful which, according to a qualitative analysis, was connected with clients` satisfaction, reasonable division of labor, cooperation with their co-workers and an increase in professional appreciation. Conclusions: This research demonstrates the benefits, as outlined by clients and PTs, of direct access to physiotherapy in the early phase as well as the use of tissue-structural classification (nociceptive pain mechanism) as one of the classifications in this stage. Clinical reasoning and critical reflection competences in the assessment of clients were important during the sub classification and during the evaluation of PTs’ own performance. Continuing learning of these competences should also be included in education programs. These results can be utilized in PTs’ direct access practice as well as when planning the content of the education program.
57 Number of Psychiatric Diagnoses and Falls in People with Huntington’s Disease (HD) in the National Inpatient Sample (NIS) , Daus D* and Srinivasan J
Background: Recent publications by the American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA) aim at guiding families and therapies in strategies that make movement in the home and the community safer for patients with HD. Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder resulting in deficits in motor, cognitive and psychiatric function. Hospitalizations due to HD and its complications are common during some stage of the illness. Falls, multiple medical conditions, poor ability to breathe or swallow and acute psychiatric distress have been noted as some of causes leading to hospitalization. Objectives: Determination of correlations between falls, severity levels, admitting diagnosis and number of ICD-10 codes for psychiatric comorbidities was reviewed in the Healthcare cost and Utilization Project (HCUP) data for the 2016 National Inpatient Sample (NIS) for inpatients with HD. Methods: Patient cases in the 4th quarter of the NIS were searched for inpatients with HD as their admitting, 2nd, 3rd and 4th diagnosis until N=230. Secondary data analysis compared variables in the NIS. Results: Level of severity was consistently higher for hospitalization within patient severity levels 2 and 3 in the sample at 72%. Severity of HD diagnosis when admitting diagnosis was HD, was statistically significant differences with the majority of inpatients injuries or fall HD severity was reported as level 2. Falls were most significantly correlated when compared to the number of psychiatric diagnosis on record (p <.001). Discussion: The most significant mild predictor of falls (33.4%) was the presence of multiple additional inpatient psychiatric diagnoses including dementia, anxiety, depression, bipolar disorder and schizophrenia. Chi-Squared analysis results indicated the greatest difference between expected falls and actual falls occurred in the presence of multiple psychiatric diagnosis’s (p<.001). Researchers in occupational and physical therapy investigating falls in the HD population could benefit from proposing psychiatric frames of reference for treatments for falls in addition to organized strategies of exercise and improvement of motor control.
58 Calculating the Acute: Chronic Workload Ratio in a Female Olympic Weightlifter: A Case Study , Serrano J, Belsito R and Serrano B*
Introduction: The idea of workload monitoring has become popular for athletes of all levels within the last 5 years with the advent of wearable technology. The purpose of this case study was to track the workload of a female Olympic weightlifter using a commercial fitness tracker. Methods: A competitive, female Olympic Weightlifter wore a commercial fitness tracker (WHOOP) for 1 month and specifically during training session. Metrics like strain, average heart rate (HR), max HR, and duration of session were tracked. The acute: chronic workload ratio was also calculated based off her programming. 2 sample t-tests were calculated between continuous variables and an ANOVA was performed between multiple continuous variables. Statistical significance was set as a p-value of (<0.05) using a confidence interval of 95%. Results: The WHOOP fitness tracker was able to calculate differences between strain and HR average (p<.001), between HR average and HR max (p<.001), HR average and Workload (p<.001), and HR max and Workload (p<.003). ANOVA analysis showed a p-value of (<.001) between all continuous variables. The acute: chronic workload ratio over the 4 weeks ranged from (0.85-1.10). Conclusion: Using wearable technology has become a cost-effective and efficient technique to track athlete workload even in the recreational population. This information can then be supplemented by acute: chronic workload ratios for more information. This can lead to clinicians, coaches, and athletes having higher quality information to improve sports performance and recovery while mitigating the risk of injury.
59 Functionality in Heart Failure Patients , Angie VG, Faysuri VM, Nathali CT* and Alejandro SO
Heart failure can be defined as the result of the alteration of different structures at the heart level (heart muscle layers and/ or great vessels) but it is mostly due to an alteration in the function of the left ventricular myocardium compromising the preload and post-load in the ventricles. In these patients there are clinical manifestations, such as: decrease in aerobic capacity, presence of choking sensation and tiredness and sometimes water retention, which can end up in peripheral edema and pulmonary congestion, evidencing an alteration in the functional capacity in their daily activities.
60 Subtrochanteric Fracture after Cannulated Screw Fixation of Femoral Neck Fractures: Biomechanical Analysis and Case Series , Page BJ*, Brennan KL and Brennan ML
Objectives: To determine whether a condensed screw construct or a dispersed screw construct is more likely to sustain a subtrochanteric fracture after cannulated screw fixation for femoral neck fractures, and to report the characteristics of the screw constructs in our patient population that sustained a subtrochanteric fracture. Methods: We performed a biomechanical analysis of two screw constructs and a consecutive case series of patients treated with cannulated screw fixation for femoral neck fractures sustaining subtrochanteric fracture. The biomechanical study consisted of two groups of biocomposite femora: (1) Condensed screw group (CS) (n=7); (2) Dispersed screw group (DS) (n=7). Axial loading was applied to the biomechanical group until fracture, and a load deformation curve was used to quantify the mechanical behavior by measuring the load (kN) at failure, displacement (mm) at failure, and initial construct stiffness (kN/mm). The case series involved a retrospective chart review of patients treated with cannulated screw fixation who sustained a subtrochanteric fracture (n=7). Radiographs were analyzed for trends in failure during chart review. Results: There was a trend towards increased load to failure in the DS group compared with the CS group. We did not observe a statistical difference (p = 0.1023) in load to failure, but we did observe increased stiffness in the DS group (p = 0.0346). Post-hoc non-inferiority analysis demonstrated that the DS were not inferior to CS group. We found a 3.9% incidence of periimplant fracture in our patient population who underwent cannulated screw fixation. Conclusion: The results of this study suggest that maximally dispersing screw placement within the femoral neck, may have higher load to failure than more condense screws. The authors of this study advocate maximizing spacing of the screws within the femoral neck while letting the anatomy of the femoral neck dictate the position of the distal screw relative to the lesser trochanter
61 Anterior Cruciate Ligament Injuries before Maturation: Surgical Complications , Babagoltabar Samakoush H* and Norasteh AA
Understanding the cause of ACL injury and its difficulties, especially before maturity, remains unknown. However, several studies have examined its prevalence in different countries and the complications of surgery in the few years after reconstruction and presented different results. According to the results of various studies in this study, a general explanation was given regarding ACL damage before puberty and complications caused by surgery in this period.
62 Congenital Dislocation of the Knee in a Newborn , Basaran T*, Alan S and Basaran PZ
Congenital dislocation of the knee (CDK) is a relatively rare condition with an estimated prevalence of 1 per 100 000 live births, which is approximately 1% of the incidence of developmental dysplasia of the hip1. It may occur in isolation, but often occurs in the presence of muscle imbalance such as that seen with arthrogryposis, Larsen syndrome, and myelomeningocele. CDK has also been reported to occur with other musculoskeletal abnormalities including developmental hip dysplasia, clubfoot, congenital vertical talus, and congenital dislocation of the elbow2.
63 Rehabilitation Considerations for Post-Surgical Patients during the Covid-19 Crisis , Thompson C*
The COVID-19 crisis has been a scare to countries, states, counties, and neighborhoods across the world. At the time of this writing, universities are shunning students from their classrooms, hospital beds are still near their limits, and the number of diagnosed positive Coronavirus patients continues to climb in the United States. Despite the increase in Coronavirus patients, physicians have resumed performing elective surgeries.
64 Comparison of Percutaneous Repair with Open Surgical Repair in Rupture of Achilles Tendon , Basaran T* and Basaran PO
Objectives: Although there is a lot of study about the treatment of Achilles tendon ruptures, it is controversial how to perform the treatment of Achilles tendon rupture and follow-up. It is aimed to compare the results of classical rehabilitation after open surgical repair and early mobilization after percutaneous repair of patients who applied to our hospital with acute tendon rupture. Materials and Methods: A total of 44 patients (12 females; 32 males) applied to emergency service with Achilles tendon ruptures were evaluated between January 2011 and June 2016. The patient was scheduled to undergo surgery for those who have a total Achilles rupture detected in magnetic resonance and who’s the Thompson test was positive, who is with a palpable ecchymosis. The mean age of the patients is 41,3 (25-58). While patients in the percutaneous repair group were treated early by local anesthesia, the open surgical repair group was operated on an average of 2 days (1-4 days). Patients were followed for a mean of 24 months. Results: Patients were evaluated with Achilles tendon total rupture score (ATRS) and the visual analogue scale (VAS). In the 12th month check-ups, the patients had a magnetic resonance imaging test and it was found that there were no problems with them. The mean ATRS (Achilles tendon total rupture score) was 71,1 in the 0th month, 76,9 in the 3rd month, 81,8 in the 12th month and 91,5 in the 24th month. The mean VAS score was 8,6 in the 0th month, 5,6 in the 3rd month, 3.1 in the 12th month and 1,5 in the 24th months. It was seen that the patients were limping due to pain while walking. It was observed that there were no problems with the wound sites and the pain decreased at 6th -week control. There were no gaps in the Achilles rupture zone, but there was thickening in the healing zone. Physical therapy was not needed because Achilles tension was not seen in the patients. They were observed as they walked slightly with a limp. The mean ATRS score was 85,7 in the 0th month, 87,1 in the 3rd month, 90,3 in the 12th month and 91,9 in the 24th month. The mean VAS score was 8,0 in the 0th month, 3,8 in the 3rd month, 2,0 in the 12th month and 1,3 in the 24th month. The surgery duration was 48,1 minutes in group A and 15,0 minutes in group B, the difference between them was statistically significant (p<0,05). While the discharge duration was 3,3 days in group A, it was 1 day in group B, and the difference between them was statistically significant (p<0,05). While the return-to-work was 81,7 days in group A, it was 22,3 days in group B, the difference between them was statistically significant (p<0,05). While VAS value was statistically significantly lower at month 0th month (p<0,05), 3rd month (p<0,05) and at 12th month (p<0,05) in group B, but no statistically significant difference wasfound between groups at 24th month (p=0,176). While ATSR value was statistically significantly lower at month 0th month (p<0,05), 3rd month (p<0,05) and at 12th month (p<0,05) in group b, but no statistically significant difference was found between groups at 24th month (p=0,942). Conclusion: The main purpose of the treatment of Achilles tendon rupture is to return to the pre-injury quality of life. Open surgical tendon repair requires long-term rehabilitation for preoperative preparation, general or spinal anesthesia, postoperative wound care, prolonged splint-splint use, and subsequent ankle stiffness. Re-rupture and calf atrophy can be seen with conservative treatment and again a long time splint is required. With percutaneous Achilles tendon repair, the duration of surgery and the length of stay were significantly reduced. Hospital costs were significantly reduced. The return of the patient to the work was significantly accelerated. The actual patient costs can be reduced by providing minimum rehabilitation period with repair of percutaneous rheumatoid rupture and early mobilization or by the help of some approaches such as ambulatory treatment, avoiding the systemic side effects of anesthesia, shortening of operating room time, more effective use of rehabilitation units, not using the device and early return to work
65 Comparing the Effects of Mirror Theraphy and Neuromuscular Electrical Nerve Stimulation (NMES) in Enhancing the Hand Functional Recovery in Patients after Stroke: A Randomized Controlled Study , Basaran PO, Bolukbasi A and Basaran T*
Objective: The purpose of this study was to assess the effectiveness of mirror theraphy and NMES in enhacing the upper extremity and hand motor and functional recovery , spasticity, and hand-related functioning and quality of life of patients after stroke. Design: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting: Rehabilitation education and research hospital. Participants: A total of 60 inpatients with stroke (mean age 61.45) were randomızed into three groups. Mirror (n:20), NMES (n:20) and Control(n:20) groups. Interventions: All patients received a conventional neuro rehabilitation treatment for 5 days a week, 2-4 hours a day for 4 weeks. In mirror group thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements and NMES applied in front of a mirror, in NMES group; the mirror was covered than NMES applied and in control group neither NMES nor mirror was applied. Main Outcome Measures: Brunnstrom motor staging for upper extremity and hand, Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM) self-care items of the FIM instrument), Nottingham Health Profile (NHP), Nine hole peg test (NHPT), superficial sense, deep sense (two point discrimination, steregnosia, graphestesia, joint position sense). Results: After the treatment, Brunnstrom motor stage improved in both mirror and NMES group but after 6 months statistically significant improvement was determinant only in mirror group(p:0.032). FIM was improved in three groups after treatment, but after 6 months improvement detected only in mirror group (p < 0,05). Spasticity ( MAS), was reduced only in the mirror group (p < 0,05). Hand skills ( NHPT) were improved only in mirror group and this improvement continued 6 months after the treatment ( p< 0,05). Quality of life was improved in both groups after treatment, but it was more in the mirror group. Conclusions: Aplıcatıon of NMES in front of a mirror is more effective on upper extremity and hand motor and functional development, hand skills and spasticity than NMES and standart theraphies of rehabilitation. This effect continues at 6 months after treatment.
66 The Role of Occupational Therapy in Concussion Rehabilitation and Symptom Management , Lew SV* and Waskiewicz M
Recently, there has been an increased focus in both the media and healthcare environment in the prevention, diagnosis, management and treatment of concussion and post-concussive syndrome. This increase in clinical concussion identification provides an opportunity for the profession of occupational therapy to promote itself as a viable option for individuals who may be experiencing difficulty in everyday occupations secondary to a concussion. Neurological dysfunction resulting from concussions, although often undetectable in conventional neuroimaging, can have considerable impact on an individual’s overall participation in everyday life activities. This article outlines common categories of client factors and performance skill deficits and their impact on occupational performance seen in the post-concussion population. In addition, it proposes the potential roles of occupational therapy practitioners in the assessment and development of treatment interventions for this unique population, while highlighting the need for more occupational therapy treatment efficacy research studies addressing this population.
67 Does Arthroscopic Lateral Retinacular Ligament Release in Patellofemoral Pain Syndrome Improve the Pain: Comparing the Techniques of Electrocautery or Scissors , Basaran T*, Atay OA, Doral MN and BaÅŸaran PO
Introduction: Pain is the main indication for surgical treatment of release in patellofemoral pain syndrome of knee. Arthroscopic lateral retinacular release in patellofemoral pain syndrome using the electrocautery or a new technique for arthroscopic lateral release with scissors. In this study we compare the VAS scale before and after the surgery in 1 month in electrocautery and scissors group and the amount of hemorrhage and time of release between the groups. Methods: 120 patients included in this prospective randomized controlled study. Inclusion criterias are over the age of eighteen and have anterior knee pain syndrome. Tightness in lateral part of knee. Despite receiving conservative treatment for 6 months. Exclusion Criteria: Diseases that prolong bleeding time. Drugs that prolong bleeding time. Abnormal APTTINR levels. Patients underwent anterior cruciate reconstruction surgery, microfracture surgery, meniscus repair surgery; synovectomy due to inflammatory diseases is excluded from the study. In this study 120 (42M 78W med age 50,24 ± 15,37 ) patients divided into three groups which was similar in age and sex. All patients underwent standard arthroscopic surgery for patellofemoral knee syndrome and meniscal debridement Group 1(Electrocautery) (n:40) Lateral Retinacular Ligament (LRL) was released with electrocautery. Group 2(Scissors)(n:40) LRL was released with Scissors .Group 3(Control)(n:40) LRL was preserved. Results: There was no difference between the groups in terms of socio-demographic characteristics. All lateral ligaments releases were performed under tourniquet. The release is not considered to be complete unless the patella can be stood on its medial edge without difficulty. In all patients, surgery duration was recorded. To calculate the amount of bleeding the blood in the drainage tube was recorded for 24 hours after surgery. For 80 patients based on clinical examination at surgery and in the immediate postoperative period, all releases were felt to be adequate. For all groups total bleeding at 24h postoperatively is the statistically same (p:0.8). In first 8 hours the amount of bleeding is more than scissors group (p:0.002). Lateral release time is longer in electrocautery group (370 seconds) than in scissors group (22 seconds). In release with electrocautery sometimes we used additional techniques for enough release. There was no difference between groups in terms of complications such as deep vein thrombosis, hemarthrosis or severe complications. Visual analog scale (VAS) was used to assess the pain in all patients before surgery and after surgery in 1 month. There were no statistically differences between the VAS in the groups before the surgery. VAS was improved in all groups after surgery, but the improvement was less in control group and this change is statistically significant. At 1 month after the surgery there was no statistically significant difference in electrocauteryand scissors group. Conclusion: In this study the amount of bleeding was the same in the groups but surgery duration was longer in electrocautery group. Pain decreased after surgery at all patients but we find further improvement with lateral retinacular release. Lateral retinacular release decreases pain. Our new technique for intraarticular arthroscopy guided lateral retinacular release uses with scissors which is simple, effective, rapid and have resulted a few surgical complications such as superficial skin infection which responds oral antibiotics. Electrocautery is difficult and needs experience.
68 Effects of Shoulder Surgery Performed on Patients with Obstetric Brachial Plexus Palsy on Remodelling and Periscapular Muscles , Hassa E*, DaniÅŸman M, BaÅŸaran T1 LeblebicioÄŸlu AG and Doral MN
Objective: Internal rotation contracture of the shoulder area developing on the follow-up of pediatric patients with obstetric brachial plexus palsy (OBPP) can lead to glenoidal and humeral head dysplasia and glenohumeral joint (GHJ) posterior dislocation. OBPP patients accompanied by the shoulder area problems and made early surgical intervention, long-term effects (> 2 years) of the balance between internal and external rotator muscle groups provided with tendon transfers and reduction of the joint on GHJ remodelling and on periscapular muscle development have been evaluated through magnetic resonance imaging (MRI) guided. Patients and methods: 14 patients with OBPP having had secondary shoulder surgery were placed retrospectively under examination to be evaluated in terms of GHJ remodelling, volumetric changes of internal (subscapularis) and external rotator muscles (infraspinatus and teres minor) groups. Current MRI of healthy sides is assessed in order to assess whether changes on patient group having preoperative and postoperative shoulder MR reviews of side with palsy are at the close rate to the healthy side. Proximal humeral head anterior ratio (PHHA) has been used for the assessment of subluxation in MRI reviews. Measured glenoid version (GV) changes have been examined in terms of seeing responses of glenoid dysplasia to surgical treatment and elliptical index (EI) changes have also been examined in terms of seeing responses of humeral head dysplasia to surgical treatment. Subscapularis (SS) and external rotators (ER) muscle groups have also been examined into areas in MRI scans and change amount has been determined by converting these values into volumetric data. Results: GV and ER values from examined parametric changes have shown statistically significant (p <0.05) change as being very close to healthy shoulder side values. In terms of last GV and ER values obtained, statistically significant difference couldn’t be found between the shoulder values of the side with palsy and the shoulder values of the healthy side. Namely, even though significant and positive changes after the surgery have been observed in terms of PHHA and SS, these values cannot catch the healthy side values. The most negative results in the study have been obtained in ER changes. Any statistically significant changes haven’t been observed in terms of ER volumetric changes after surgery. Conclusion: In the cases with OBPP accompanied by the shoulder problems it has been found that significant osseous remodelling has been provided with surgery of early secondary shoulder region in long-term follow-up
69 Physiotherapy for Low Back Pain , El Geziry AF*
The biopsychosocial model for pain management is widely accepted worldwide. As the mechanisms of pain is multidimensional, management should also be multifaceted, in the core of subacute & chronic pain management, physiotherapy might be considered almost for every & each patient Several mechanisms have been adopted to explain how physical therapy help such wide category of patients. When planned properly, the benefits are many, & side effects are less, patient selection& education plays a crucial role to achieve these goals.
70 The Effects of Dry Needling on Tinnitus: A Case Study Report , Woods L*
Background: Tinnitus is the perception of sound when there is no acoustic source external to the ears. Zenner, et al. proposed conductive, sensorineural, and central as the generation sites for tinnitus. Although dry needling has been primarily suggested to treat pain, scholars have explored dry needling for its positive effects on inflammation and function. In this case study the clinician used dry needling under the premise that the patient’s tinnitus was of sensorineural origin due to cranial nerve V and cranial nerve VII inflammation. Case Presentation: A 48-year-old male with a chief complaint of left ear tinnitus. During examination, sensation, reflexes, range of motion, strength, and cranial nerve function were all noted at intact or functional with the exception of the left vestibular cochlear nerve. A novel dry needling protocol was created and resulted in an immediate resolution of left ear tinnitus. Although symptoms returned, full resolution of tinnitus was reported after five dry needling sessions. Discussion: Dry needling following an adapted Integrated Dry Needling® approach alleviated tinnitus after five sessions. The proposed mechanism for tinnitus resolution was cranial nerve V and cranial nerve VII dysfunction, which was decreased after each dry needling session. Limitations: The clinician did not assess the temporomandibular joint, control for diet or medications, and was unable to quantify the pathophysiological mechanism of resolution.
71 Cranial Loading: The Plight of the Rural South African Female , Kurten M*, Motaung TG, Paul Y and Ellapen TJ
The domestic responsibilities of rural female South Africans are to clean, cook, do laundry, collect food, water and firewood and chaperone children and elderly. Most rural families live in abject poverty, rendering them unable to purchase motorized vehicles to assist with transportation. The most popular method of transport is cranial loading porterage. This short commentary highlights the reasons why rural South African females still persist with this method of transportation. Further the innovative halo-head loading cervical support brace designed to assist cranial loading porterage will be discussed.
72 A Cross-Sectional Study of the Cameroonian Elite Basketball Players towards their Physical Activity Attitudes Due to the Covid-19 Pandemic , Guessogo WR*, Bika Lele CB, Assomo Ndemba PB, Mekoulou Ndongo J, Hamadou A, Mban Bian W, Djomo Ngnoko EE, Guassen IM, Mandengue SH and Temfemo A
Introduction: The coronavirus pandemic (COVID-19) led to adaptations in all sectors of activity. The study aimed to assess physical activity attitudes of Cameroonian elite basketball players due to COVID-19 pandemic. Methods: A total of 86 basketball players completed a questionnaire to collect anthropometric parameters before and after relaxation, physical activity maintenance, number and type of training sessions, and opinion on physical capacities during and after confinement. Results: 72.8% of the participants experienced weight status variation. The majority (81.5%) continued training during the confinement, 77.3% trained at home and alone (80.3%), 55.3% increased training sessions alone, 84.9% reduced group training sessions and 97.4% reduced training sessions with coach. About 61.8% preferred physical training, and 82.4% muscle strengthening exercises instead of aerobic exercise (10.3%). About 60.5% maintained strength, lost speed (60.5%), and endurance (74.1%). After the first training session, coach qualified the physical capacities as average (55.6%). Conclusion: COVID-19 impacted physical activity attitudes. Measures should be developed to reduce the impact of confinement in return to sport.
73 Effect of Pilates Vs. Yoga on Balance, Cognition and Core Strength in Elderly , Khandare S, Thakkar V*, Palekar T, Desai R and Basu S
Background: In older people, falls have become a major health issue. People aged 65and above are more prone for most frequent accidents which can lead to injury related hospitalisation. Elderly people have many serious health issues and they have several disorders affecting their body at the same time. Pilates is kind of exercise that uses a combination of muscle that increases power, stretches muscle and also concentrate on breathing to develop strength of the trunk muscles and restore muscle balance for physical fitness. Yoga is the active engagement between the mind and body. Yoga focuses specifically on what is exactly happening is the body and where the body is actually moving in space which increases both awareness and proprioception. Objective: To study the effect of Pilates on balance, cognition and core strength. To study the effect of Yoga on balance, cognition and core strength. To compare the effect of Pilates Vs. Yoga on balance, cognition and core strength in elderly. Method: There were two groups Pilates and Yoga. 30 subjects were sequentially divided in both groups. The treatment was given for 3 days a week for 4 weeks. The outcome measures were taken at the beginning and at the end of 4th week. Result: The Pilates group is having statistically significant improvement in balance .The Yoga group is having statistically significant improvement in cognition. The core strength is clinically significant in Pilates group. Conclusion: This study concluded that Pilates and Yoga both are equally effective in improving cognition, balance and core strength at the end of 4 weeks protocol, yoga group showed marked increase in cognition whereas pilates group showed marked increase in balance and core strength.
74 Investigating Strength Effects at the Shoulder Using Blood Flow Restriction , Green LL*, Cupp JL, Cole E, Craig D, Crawford K, Hogan S, Holsted J, Lovell H and Sarna M
Introduction: The purpose of this study was to assess the effects of blood flow restriction (BFR) on proximal musculature of the upper extremity. This randomized control trial study design used manual muscle testing and one repetition maximum (1RM) as the main outcome measures to test the strength of the pectoralis major, lower trapezius, rhomboid, serratus anterior, and external rotator muscles. Methods: Eleven males completed the following exercises two days per week for four weeks at the student recreation center: bench press plus, scapular retraction, shoulder external rotation (ER), and bent over rows. Six subjects received BFR to their dominant arm and performed four exercises at 20% of their 1RM. Five control (CON) subjects followed the American College of Sports Medicine (ACSM) strength and hypertrophy protocol at 70% of their 1RM. Results: A significant difference was noted in both pectoralis major and lower trapezius strength (p < 0.05) and in 1RM for prone rows for the BFR group. A significant difference was noted in pectoralis major, lower trapezius, and external rotator strength and in 1RM for scapula retraction for the CON group. A significant difference was noted between groups for pretraining for the pectoralis major. Conclusions: Completing BFR at 20% of 1RM produces the same post-training strength gains in the serratus anterior, external rotator, rhomboids, lower trapezius, middle trapezius, and pectoralis major muscles as the implementation of high resistance exercise. Based on the results of this study, lighter weights using a BFR protocol is as effective in gaining strength as using high resistance exercise.
75 Effect of Transcranial Direct Current Stimulation on Balance and Stroke Specific Quality of Life in Stroke Patients , Shah H*, Khandare S, Siddapur T, Basu S and Palekar T
Stroke is the leading cause of disability which requires rehabilitation. It is defined as obstruction or restriction of blood supply to the brain, usually because a blood vessel supplying brain is burst or blocked by a clot; causing damage to the cells of brain. This in turn may result in physical and/or mental disabilities. Upper limb functions are most commonly impaired following stroke; which also deteriorates activities of daily living. tDCS is a novice approach which can improve upper limb function by modulating cortical neuronal excitability. Objective: To investigate the effect of cathodal, anodal and sham tDCS on balance and stroke specific quality of life in stroke patients. Method: 30 stroke patients meeting inclusion criteria were randomly allocated into three groups. Group A, B and C received cathodal tDCS, anodal tDCS and sham tDCS respectively. The intensity of the current was 2mA given for 20 minutes along with all the upper limb active and fine motor exercises. It was given for 12 sessions in 3 weeks. Berg balance scale and stroke specific quality of life questionnaire was taken to assess lower limb function respectively. It was taken before and after the 3 weeks. Result: paired t test showed that the balance improved before and after treatment with cathodal (0.003) and anodal (0.000) tDCS and sham stimulation (0.917) and also for SSQOL cathodal and anodal showed improvement in quality of life but sham stimulation showed no improvement. (0.173). Kruskal Wallis Test showed significant difference in between the groups (p<0.05) which showed balance improved more in anodal tDCS than cathodal and sham. Also cathodal tDCS balance compared to sham tDCS. but in SSQOL there was no significant improvement seen in all three groups. Conclusion: Both cathodal and anodal tDCS improve balance over sham tDCS. Improvement of balance with anodal tDCS was better than cathodal tDCS. There was no change in SSOL.
76 Physical Exercise and Covid-19 Updated Recommendations for Cardiorespiratory and Immune Systems , Enriquez Del Castillo LA*, Carrasco Legleu CE and Flores Olivares LA
Since the declared health emergency due to the appearance of the SARS-CoV-2 virus, primary prevention measures have been established; however, little has been said regarding to regular physical exercise, despite the fact that there is evidence that physical exercise helps to strengthen the cardiorespiratory and immune system, so there is a possibility that this could be a method of prevention and as therapy after recovery , since people with a weak immune system and whith a systemic inflammation processes are more likely to get this virus. That is why the present research aims to show updated evidence aboutt he regular practice of physical exercise and its benefits during and after this lockdown.
77 Occupational Participation of Mothers of Children with Autism Spectrum Disorder , Haq AN and Santoso TB*
Background: Mothers of children with ASD are faced by great challenges trying to follow and establish a daily routine. Participation in personally meaningful occupations is often sacrificed to focus their time on providing the needs related to child care/child rearing. Objectives: This study aimed to obtain a deep understanding of occupational participation of mothers of children with ASD as well as the challenges they faced and how they cope with those challenges. A qualitative research method was adopted. Method: Using phenomenological approach, data were gathered through in-depth, semi-structured interviews with six mothers. Results: Five themes related to occupational participation of mothers of children with ASD emerged from the thematic analysis that has been conducted, which are (1) being constantly occupied, (2) restricted participation in meaningful occupations, (3) challenges of raising a child with autism spectrum disorder, (4) impact on mother, and (5) coping and support. Conclusion: Mothers of children with ASD find it difficult to participate in occupations that are meaningful to them. Hence, there is a need for occupational therapists to support them in improving satisfaction and engagement in meaningful occupations.
78 Ankle-Foot Orthoses in Spinal Cord Injury: Systematic Review of Literature , Ciardi G and Galli M*
Background: Spinal cord injury patient present gait abnormality, and this can compromise physical and mental health. AnkleFoot Orthosis are the most used orthoses in the walking rehabilitation of these patients. Aim: The aim of this review was to overview types, characteristics, function and efficacy of ankle-foot orthosis in the rehabilitation of SCI patients, based on the literary EBM. Methods: A systematic review was conducted throught a clinical query based on PICO method. Studies were identified in Pubmed, MEDLINE, ISI Web of Knowledge, EDS Base Index, PEDro, NARCIS database. PRISMA Statement was used to report results, and Newcastle-Ottawa Castle was used to assess quality of the articles. Results: The review included five cohort studies. Four studies used hinged AFOs and compared them with other orthoses for the walking rehabilitation of SCI patients. Two studies concerned powered AFOs, and two other ones combined them with other rehabilitation devices. According to the Newcastle-Ottawa Scale, all studies scored 6/7 and 7/7. Discussion: Hinged AFOs provided the best performance and effective devices, especially in the rehabilitation context. Powered AFOs are innovative orthoses with a great evaluative, therapeutic and prognostic value. They can promote recover of walking ability in SCI patients. A comprehensive rehabilitation programme, using hands-on techniques, aids and orthoses together with AFOs is effective and better than the single use of a device.
79 Games and Didactic Exercises to Promote Graphomotor Development in Preschool Children in Children with Intellectual Disabilities , Bestard Revilla AC*
The present work offers a proposal of games and exercises to develop fine motor skills in children aged 4 to 5 with intellectual disabilities, based on the preparation of the educator and the family who interact with them. Fine motor skills during the preschool stage start from the acquisition of experiences from previous ages to act with objects with greater precision and dexterity that will allow them to reach other contents that expand their knowledge, such as writing. Methods of the theoretical level and the empirical level were used, which helped to reveal the results of the diagnosis. The application of these games and didactic exercises can promote the development of fine motor skills in these children, which will influence a better preparation of these for higher learning.
80 Using Children Play as Therapy , Simunovic D*
To play is every child’s universal right. Children have the right to rest, to be included in play and participate in age appropriate recreational activities. The experience of children and young people in playing affects their psycho-physical development. Playing contributes to the development of childhood friendships and enables children to learn and develop various roles in life.
81 Physical Activity: Covid-19 Can’t Stop Us , Pereira F*
As SARS-CoV-2, or Covid-19, continues to keep billions under lockdown, a return to normalcy seems distant. World leaders have declared that a vaccine may not be available in the near future; that we may have to learn to live with the virus. In order to mitigate infection, gyms and fitness centers have been closed, as they are deemed places of secondary transmission.
82 An Increasing Emphasis of Evidence-Based Practice in Children with Developmental Disabilities , Allyson MSP* and Joydeep DC
Background: In response to demands of client care and constraints of limited healthcare resources, it is necessary to identify the precise nature of current research trends in occupational therapy in the United States. Objectives: The specific aim of this study was to explore the common themes of occupational therapy research over a ten-year period (2007-2016), and how this research has evolved. Methods: Articles published in the American Journal of Occupational Therapy from 2007-2016 were analyzed. Results: Majority of the studies focused on the improvement of behavior in children with developmental disabilities through various occupational therapy interventions. In addition, there was an increased focus on the generation of valid and reliable data promoting evidence-based practice. Conclusions: This study demonstrates that current research in occupational therapy is focused on interventions in children which aligns with the American Occupational Therapy Association’s Framework-III (2014) supporting interventions that promote healthy development in children.