Efficacy of low-Intensity Pulsed Ultrasonic on Bone Mineral Density in Osteoporotic Postmenopausal Women

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Indian Journal of Physiotherapy and Occupational Therapy www.ijpot.com

Contents Volume 06 Number 03

July - September 2012

1.

A Study of Correlation Between Depression, Fatigue and Intelligence in Parkinson’s Patients ..................................... 01 Phansalkar Archana A, Iyer Saraswati

2.

Role of Aerobic and Resistive Exercises in Postmenopausal Women .................................................................................. 07 Abha Sharma, Heena Sahi

3.

Quality of Life, Disablement, Comorbidity and Socio-Demographics of Stroke ............................................................... 13 Survivors in South-Western Nigeria Aderonke O. Akinpelu, Caleb A. Gbiri, Fatai A. Maruf

4.

Efficacy of Mesh Glove Sensory Stimulation on Spasticity Control in Hemiplegic C.P. .................................................. 19 Ahmed M. Azzam

5.

Rehabilitation of a Patient with Post Traumatic Triple Nerve Palsy of the Upper Limb .................................................. 24 Anil Mathew

6.

The Effectiveness of Iontophoresis Over Conventional Therapy in Relieving Pain, ......................................................... 28 Improving Rom and Functional Skills in Adhesive Capsulitis Anila Paul, Nizar, Thresiamma VT

7.

Comparison of Dynamic Balance Between Flat Feet and Normal Individuals .................................................................. 33 Using Star Excursion Balance Test Ajit Dabholkar, Ankita Shah, Sujata Yardi

8.

Evaluation of 6 Minute Walk test Parameters in Normal Indian Pediatrics age Group between 6-11yrs ..................... 38 Jinal Chitroda, Anuprita Thakur, Sujata Yardi

9.

Effect of Posterior Tibial Nerve Stimulation and Trospium Hydrochloride in .................................................................. 42 Treatment of Overactive Bladder Syndrome: A Randomized Controlled Study Anwar Abdelgayed Ebid, Shamekh Mohamed El-Shamy, Ali Abd El Monsif Thabet

10. Pulse Rate Response to Footwear in Rehabilitation Phase of Coronary Artery Bypass .................................................... 48 Graft Surgery (CABG) Patients– A Clinical Trial Study Shaily Razdan, Aparna Sarkar 11. Effect of Passive Pelvic Fixation on Non-Specific lumbopelvic Pain: A Case Report ........................................................ 53 Apeksha A, Khatri SM 12. A Prospective Experimental Study of Effects of Cognitive Tasks on Balance In Stroke Individuals .............................. 57 Ami Timbadia, Archana Gore, Saraswati Iyer, Laxmiprabha Rangarajan, Amita Mehta 13. A Cross-Sectional Study on the Significance of Side Step Length for Dynamic ................................................................. 62 Balance Assessment in Ambulatory Stroke Subjects ARJU B, Joshua A.M., Ganesan S.

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II 14. Effectiveness of Sensory Re-education after Nerve Repair (Median or Ulnar Nerve) at the Wrist Level ...................... 68 B. Anandha Priya 15. A Comparative Study Between High Side Lying and Side Lying Position on ................................................................... 75 Oxygen Saturation in Preterm Infants Bhanu Thapar, C. Janarthanan, Jagmohan Singh, Aarti Sareen 16. Efficacy of Knee Osteo-arthritis Outcome Score (KOOS) in Measuring .............................................................................. 79 Functional Status of Knee Osteo-arthritis Patients in the Indian Population Bindya Sharma 17. Reliability and Concurrent Validity of Dynamic Rotator Stability Test —A Cross Sectional Study .............................. 82 Binoy Mathew K V, Charu Eapen, P.Senthil Kumar 18. A Randomised Controlled Trial of Stimulation of Triceps as an Adjunct to ...................................................................... 88 Motor Training of Paretic Arm in Stroke Patients Uma Prabhu, Archana Gore, Saraswati Iyer, Amita Mehta, RajashreeNaik 19. The Effect of Task Oriented Training on Hand Functions in Stroke .................................................................................... 93 Patients- A Randomized Control Trial Chandan Kumar, Ruchika Goyal 20. Effects of Three Weeks Plyometrics on Sprint Velocity ......................................................................................................... 98 Jagdeep Kaur Dhamija, Jaspreet Singh Vij, Rajesh Gautam 21. Perception about Stroke amongst Rural Population in Maharashtra ................................................................................ 101 Swati Limaye, Deepak Anap, Dhiraj Shete 22. To Study and Compare the Effect of Laptop Computers with Desktop ........................................................................... 106 Computers on Working Posture and Self-Reported Musculoskeletal Symptoms Aditi Biswas, Dheeraj Lamba 23. An Analysis of Memory Retrieval and Performance of Physiotherapy ............................................................................ 111 Exercises in Younger and Older Patients Dhiraj R. Shete 24. Effectiveness of Physiotherapy for the Handwriting Problem of School Going Children ............................................. 117 Chandan Kumar, Poonam Mehta, Sobika Rao 25. Effect of Kinesio Tape in the Treatment of Antenatal Carpal Tunnel Syndrome ............................................................ 122 Soheir M. El Kosery, Fayiz F. Elshamy, Hamid A. Atta Allah 26. Effect of Antenatal Exercises on Umbilical Blood Flow and Neonate ............................................................................... 127 Wellbeing in Diabetic Pregnant Women Hanan Sayed E-Mekawy, Adly Ali Sabbour, Mohamed Mostafa Radwan 27. Efficacy of Active Release Technique in Tennis Elbow – A Randomized Control Trial ................................................. 132 Harneet K M, Khatri SM 28. Study of Cognitive Impairment in Parkinson's Patients and its Correlation with Freezing of ...................................... 136 Gait Episodes and Bradykinesia Hutoxi, Poorva Kulkarni 29. Study of Trunk Movement Deficits in Golfers with Low Back Pain .................................................................................. 141 Navneet Kalra, Jagmohan Sing, Masilamani Neethi 30. A Longitudinal Study to Analyse & Quantify Functional Capacity Post- Coronary Artery Bypass Grafting ............ 145 Ruchi Katyal, Jamal Ali Moiz, J. Jayaprakash

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III 31. A Comparative Study Between Muscle Energy Technique and Myofascial Release ...................................................... 150 Therapy on Myofascial Trigger Points in Upper Fibres of Trapezius Jay Sata 32. Quantifying Emg Activity of Trapezius Muscle During Empty Can & Full Can Tests .................................................. 155 Kanupriya, Sumit Kalra 33. Socio-Economic Barriers to Maternal Health Care in Rural Bangladesh ........................................................................... 162 Lori Walton, Bassima Schbley 34. Effect of Sensory-Specific Balance Training in Elderly ......................................................................................................... 168 Manjiri Puranik, Saraswati Iyer, Archana Gore, Lakshmi Prabha, Poonam Khachane, Amita Mehta 35. A Comparitive Study of Early Intervention Programme vs Home .................................................................................... 173 Intervention Programme in Preterm Infants Manpreet Mann, C Janarthanan, Kusum Mahajan, Jagmohan Singh 36. A Study to Compare the Effectiveness of Conventional Treatment Versus ..................................................................... 178 Temporomandibular Joint Mobilization in Patients with Temporomandibular Joint Disorders Jay Sata 37. Effect of Home Based Low Intensity Walking Programme on Quality of Life and Functional ..................................... 185 Capacity in Left Ventricular Failure Patients – A Randomized Control Trial Mariya Jiandani, Rajeshwari Reddy, Amita Mehta, Ashish Nabar 38. Effect of Exercise on Postural Kyphosis in Female after Puberty ....................................................................................... 190 Hala M. Hanfy, Mohamed A. Awad, Abdel Hamid A. Atta Allah 39. Effect of Nerve Mobilization on Vibration Perception Threshold in Diabetic Peripheral Neuropathy ........................ 195 Pankaj Preet Singh, Supreet Bindra, Sandeep Singh, Rohit Aggarwal, Jagmohan Singh 40. A Study of Immediate Effects of Taping in Patients with Knee Osteo-arthritis ............................................................... 202 Pooja Arora, Shilpa Arya, Sujata Yardi 41. The Effects of Upper Limb Exercises on Hand Writing Speed ........................................................................................... 208 Nilukshika KVK, Nanayakkarawasam PP, Wickramasinghe VP 42. To Study the Effect of Gluteus Maximus Activation in Sub Acute Mechanical Low Back Pain .................................... 214 Rajiv Sharma, Subhash Mahajan, Jagmohan Singh 43. Epidemiology of Cerebral Palsy in Jalandhar ........................................................................................................................ 219 Raju Sharma, A.K.Purohit, E. RajinderaKumar, S. Perssona, A.G.K.Sinha, S.K. Tripathy 44. Modified Quadriceps Strengthening Maneuver for Patients Undergoing Acl ................................................................. 223 Reconstruction-surface Electromyogrphic Analysis JAY SATA 45. A Comparison Between Land-based and Water-based Balance Training Exercise ......................................................... 227 Program in Improvement of Balance in Community Dwelling Elderly Population Ramandeep Walia, Shefali 46. Effect of Aerofic Exercise on Functional Capacity in Asymptomatic Coronary Artery Disease ................................... 234 Risk Factors Subjects Ravinder Narwal, Gurpreet Chawla 47. Clinical Outcome in Adult Ventilated Patients Using Multimodality Chest Physiotherapy ......................................... 240 as Treatment Approach: A Single Blinded Randomized Clinical Trial Renu B Pattanshetty, Gajanan.S Gaude

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IV 48. Efficacy of Low-Intensity Pulsed Ultrasound on Bone Mineral Density in ...................................................................... 244 Osteoporotic Postmenopausal Women Ali A. Thabet, Omar F. Helal, Shamekh M. El-Shamy 49. Cardiovascular Co-morbidity and role of exercise in Rheumatoid Arthritis: A Review ................................................ 249 Anwer Shahnawaz, Equebal Ameed 50. Physiotherapy-supervised Mobilization and Exercise Following ...................................................................................... 254 Total Knee Arthroplasty Surgery: a Questionnaire Survey B.Sankarmani, V.Seetharaman 51. The Effect of a Single Session of Static and Ballistic Stretching on Lower Limb .............................................................. 259 Power in Sedentary Individuals Sharmella Roopchand-Martin, Domonique Freckleton 52. Autonomic Adaptation and Functional Capacity Outcomes after Hospital-Based ......................................................... 263 Cardiac Rehabilitation Post Coronary Artery by Pass Graft Sherin Hassan Mohammed Mehani 53. Analysis of the Influence of Fear of Fall on the Score of Berg Balance Scale among the Elderly Population .............. 268 R. Sivakumar, C.M. Radika 54. Impairment of Spinal Proprioception Following Stroke ...................................................................................................... 272 Shruti S, Alagumoorthi G, Suresh Kumar 55. A Cost-effective Patient Designed Hand Splint for Rehabilitation after ........................................................................... 277 Two-stage Flexor Tendon Reconstruction Muhammad Adil Abbas Khan, Mark Gorman, Arvind Mohan, Zain A. Sobani, Alastair Platt 56. Comparative Study Between Auditory, Visual and Combined EMG Biofeedback in .................................................... 280 Management of Patients with Tension type Headache Veena Bembalgi, Karkal Ravishankar Naik 57. Effect of Manual Therapy Techniques on Knee Proprioception in Patients with Osteo-arthritis of Knee ................... 285 Singh Yuvraj Lalit, Mhatre Bhavana Suhas, Mehta Amita

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A Study of Correlation Between Depression, Fatigue and Intelligence in Parkinson’s Patients Phansalkar Archana A1, Iyer Saraswati2 Neurology, Prof and Guide, Department of Physiotherapy, G.S. Medical College, Parel, Mumbai

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ABSTRACT Purpose of the Study: To evaluate depression, fatigue, intelligence in Parkinson patients and find if correlation exists between them and the disease severity. Material and Methods: 30 patients with idiopathic Parkinson’s disease (PD) on conservative treatment and who could answer various questionnaire by themselves were selected. Patients with any other neurological disorder or complications were excluded. Patients were assessed on the UPDRS, Hoen and Yahr scale and Schawb and England scale and then were asked questions from the Beck Depression Inventory (BDI) which gave a total score of depression. The patients were assessed for intelligence by the MMSE. The patients were then asked questions from the ‘Fatigue Severity Scale’. Results: Data were analysed by the statistical test of “Correlation coefficient” and results were obtained as follows:  Positive correlation between depression and disease severity.  Negative correlation between intelligence and disease severity, between depression and intelligence and fatigue and activities of daily living.  63.3% patients severely affected on BDE.  40% mild to moderately affected on MMSE. Conclusion: There is a definite non motor / Psychological affection in idiopathic Parkinson’s disease

INTRODUCTION The clinical diagnosis of PD is based on the obvious impairments of movement that are the motor symptoms of tremor bradykinesia, rigidity and postural imbalance1. Apart from motor impairments there are some nonmotor / psychological affection which may be complicating the disease process. Most common of the akinetic rigid syndromes PD affects 1% of adults over 50 years of age with increasing frequency in older age groups affecting both sexes equally2. Along with the inhibition of movement and other motor symptoms, the nonmotor symptoms of PD fall into: Affective disorders (depressive symptoms) Cognitive decline Changes in personality and personality triats These symptoms of depression, reduced intelligence and fatigue are markedly seen in PD and

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have a significant impact on the lives of the patient. They reduce the interest of the patient in rehabilitation which further increases the bodily (motor) symptoms thus reducing the ‘Quality of Life’. It is a very unfortunate situation when the psychological aspects of the disease are deemphasized, not gaining attention in the treatment as the motor symptoms in PD. Aim: To evaluate depression, fatigue and intelligence and PD patients and to find if a correlation exists between them and the disease severity. Depression It is described as sadness of mood, loss of interest and pleasure in almost all activities. Depression in PD is usually characterized by dysphoria pessimism, somatic symptoms and mild intellectual impairment and is classified as • Endogenous and Reactive depression

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2 Indian Journal of Physiotherapy & Occupational Therapy Letter. July-Sept., 2012, Vol. 6, No. 3

Endogenous depression is due to various neuropathological processes occurring in the disease. Reactive depression is a mental reaction to motor disability occurring in the disease.

The connections between the striatum and the prefrontal cortex also described as Dorsolateral prefrontal circuit., Lateral orbitofrontal circuit., Anterior cingulate circuit. (Alexander et al 1986)

A biological basis explained is: MONOAMINE HYPOTHESIS24 The first major theory about biological etiology of depression hypothesized that it was due to a monoamine neurotransmitter deficiency notably Norepinephrine (NE) and serotonin (5HT). 5HT production is analogus to NE and DA except for a requirement of a different amino acid – tryphtophan.Thus, these neurotransmitters are very important and their formation if stopped at any stage - Depression. NEUROTRANSMITTER RECEPTOR HYPOTHESIS: According to this, an abnormality in the functioning of the receptors leads to depression. INTELLIGENCE The prefrontal cortex is the locus is higher intellect in human beings, Ablation of the frontal lobes would lead to 1. Inability to solve complex problems,sequencing tasks 2. loss of ambition, 3. inability of do several parallel tasks at one time. The above problems are also seen in our patients. The explanation for this pattern of impairment has been sought by the close anatomical associations between the striatum and the frontal cortex.Delong et al (1984) described two ’neuronal loops’ connecting the striatum and frontal cortex via the discrete regions of thalamus:

Fig. 1.

Fatigue: Fatigue is described as a lack of energy, sense of tiredness and feeling of exhaustion which can be due to peripheral mechanism and central mechanism. Fatigue occurs in any physical or mental illness. Inactivity due to any reason would lead to “stress” and increased fatigability. Akinesia often feels likes fatigue in PD. Muscles fatigue is also due to stiffness, cramps and tremors. Loss of muscle strength reduces stamina and endurance leading to fatigue. Integrated scheme of potential mechanism between physical illness and fatigue Physical illness Pain

1. Motor loop linking the putamen with the supplementary motor cortex. 2. A ‘complex loop’ linking the caudate with prefrontal cortex.

Depression

Direct Physical

Treatment

Mechanism Sleep Disturbance Fatigue Behavioral and deconditioning

The intimate functional as well as anatomical association between prefrontal cortex and head of the caudate has been shown causing equivalent impairments following lesions to either region.Also lesions to the nuclei involved in the caudato prefrontal loop had a significant effect on cognitive function, unlike those lesions placed in the thalamic nuclei, involved in the motor loop. (Fig. 1)

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MATERIAL AND METHODS 1. 2. 3.

Unified Parkinson’s disease rating scale(UPDRS) Beck depression inventory (BDI) Fatigue severity scale (FSS0

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Indian Journal of Physiotherapy & Occupational Therapy Letter. July-Sept., 2012, Vol. 6, No. 3 3

4. 5.

Mini mental status(MMSE) Schwab &England activites of daily living.

The above table shows negative correlation between UPDRS and MMSE suggesting, intelligence reduces with increase in disease severity .

Inclusion Criteria: 1. 2. 3.

Patients with idiopathic PD on conservative Rx. Patients who are able to answer the various questionnaire by themselves. Patients who understand at least one of the 3 languages – English, Marathi, Hindi.

Exclusion Criteria: 1. 2. 3.

Patients with any other neurological disorder than idiopathic PD. Patients with a history of any surgical intervention for the Rx of Pd. Patients having PD secondary to any other cause eg;Parkinson’s plus syndrome.

Table 4. Hoen & yahr and MMSE Samples size HOEN&YAHR MMSE

Mean

SD

r

t

P

30

2.28

+0.79

-0.74

5.84