Perceived Environmental Barriers to Community Participation in Stroke Patients
Co- Author: Nivedita Shahane
Aim: To determine the environmental barriers to community participation perceived by stroke patients
Objective: To identify the physical and non-physical environmental factors perceived as barriers to community participation by stroke patients. Design: Observational and Prospective. Setting: Tertiary care centre. Participants: 20 stroke patients with hemiplegia, ambulatory (with/without assistive devices) and community-dwelling voluntarily participated. Patients with severe cognitive, visual, perceptual and communication deficits were excluded. Convenience sampling was used.
Main outcome measure: A questionnaire was designed based on the domains of International Classification of Functioning and Disability; and included elements of physical and social environments. This was administered through a semi-structured interview.
Result: Among the various factors identified, mobility barriers community (e.g., uneven sidewalks, unavailability of lifts) and at home (e.g., stairs or doors) have been implicated to limit community participation by majority of subjects (95% & 85%) followed by lack of accessibility of roads (95%), lack of accessibility of restrooms (55%) and lack of accessibility of transport (45%). Lack of services, systems and policies was perceived as a barrier and inappropriate attitude and lack of support of family and friends by 25% and 20% subjects respectively.
Conclusion: Environmental factors are crucial determinants of community participation in stroke patients. Along with physical environmental factors, social and attitudinal aspects of environment also have an impact on community participation by stroke patients. Clinical Implications: Knowledge of these findings will assist rehabilitation of stroke patients by overcoming barriers and enhancing facilitators through environmental modification in community for easy accessibility, training in community/in a simulated environment and policy changes e.g. changes in regulations, insurance, etc.
Effect of Trunk Extensor Muscle Fatigue on Postural Stability in Healthy Young Adults
Co- Author: Saili Mulgaonkar
Objective: To determine the effect of trunk extensor muscle fatigue on postural stability in healthy young adults using clinical measures
Design: Prospective, experimental, within subject, repeated measures design Setting: Tertiary care hospital and research centre
Participants: 70 healthy adults in the age group of 20 to 25 years, volunteer sample Intervention: Fatigue of trunk extensor muscles was induced by repeated dynamic contractions performed to maximum exhaustion. Postural stability was assessed under three different conditions viz. No fatigue, Fatigue and Recovery.
Main Outcome Measures: One-leg standing balance test and Functional reach test were used to assess static and dynamic postural stability respectively.
Results: Wilcoxon matched-paired signed ranked test was used for comparison of postural stability in No fatigue and Fatigue condition with p-value<0.001. One-leg standing balance test showed a significant decrease from No fatigue (15.16+8.47 seconds) to Fatigue (5.89+5.7 seconds) condition. Functional reach test values showed a significant decrease from No fatigue condition (12.34+2.61 inches) to fatigue condition (12.27+2.6 inches). Mean recovery time was 12.5+3.27 minutes for One-leg standing balance test and 11.93+3.22 minutes for the Functional reach test. Further analysis using Mann Whitney test showed no significant difference (P=0.288) between the recovery time of one-leg standing balance test and functional reach test.
Conclusions: Trunk extensor fatigue significantly affects static and dynamic postural stability in healthy young adults. Complete recovery takes 12.5+3.27 minutes for static and 11.93+3.22 minutes for dynamic postural stability. Results of this study stress the importance of intact trunk extensor muscle function on the regulation of static and dynamic postural stability in healthy young adults. However, more studies are required to determine the effect of trunk extensor muscle fatigue using other clinical measures and in individuals with neuromuscular disorders.
Click to access fa1c7bb14e1dd76452b4aefd8d0064f1db99.pdf
Fear of Falling and Associated Variables in Community-Dwelling Elderly
Co- Author: Dohadwala Sakina
he purpose of this study was to determine the prevalence of fear of falling and its association with fall, avoidance of activity, balance deficits and risk of fall in community-dwelling older individuals. It was a cross-sectional study conducted in general community setting. Fifty community-dwelling elderly (mean age of 77.98 ± 2.83years), ambulatory, without any severe medical conditions participated in the study. Main outcome measures of the study were fear of falling (FOF), fall and activity avoidance assessed through an interview-based questionnaire; balance assessed using Berg Balance Scale (BBS); balance confidence assessed using Activities-specific Balance Confidence (ABC) scale. FOF and associated avoidance of activity was reported by 60% and 52% of the elderly respectively. In subjects reporting FOF, 76% were fallers, 44% being non-fallers. BBS score of the subjects reporting FOF was significantly lower (42.7 ± 10.12) than the subjects without FOF (53.65 ± 3.51). Also, the subjects with FOF had a score below 46, the cut-off point for predicting risk of falling. In subjects having FOF, 56.66% had low risk of falls and 43.33% had medium risk of falls whereas all the subjects with no fear of fall had low risk of falls. Subjects FOF reported a significantly lower balance confidence on ABC scale as compared to subjects without FOF. Thus, it is concluded that FOF and associated avoidance of activity are highly prevalent in the community-dwelling older people. FOF is significantly associated with fall/s, balance deficits with an increased fall risk, avoidance of activity and low balance confidence in doing activities of daily living. FOF can be considered as a significant health problem of equal importance to a fall. This study highlights the importance of identifying FOF and addressing factors related to it in the rehabilitation of the elderly.
Click to access 10.11648.j.ajap.20170606.13.pdf
Immediate Effect of Nadishodhana Pranayama on Functional Mobility in Stroke Patients
Co- Author: Aditya Rajput
Objective: To determine the immediate effect of nadishodhana pranayama on performance of a clinical functional mobility task in stroke patients.
Design: Experimental, within subject, pre and post design.
Setting: Tertiary Care Hospital and Research Centre.
Participants: 16 Stroke patients consisting of 11 males and 5 females with an average age of 51 ± 12.43 (S.D) yrs.
Intervention: Nadishodhana Pranayama was administered to ambulatory stroke patients in a quiet, spacious, well-lit room. Functional mobility was assessed before and immediately after the practise of Pranayama.
Main outcome measure: Timed up and Go test (TUGT)
Results: The average Timed Up and Go Test (TUGT) time in seconds was 33.43 ± 19.56 before and 26.06 ± 20.69 after the practice of Nadishodhana Pranayama. The Wilcoxon Signed Rank Test was applied to this data which proved the difference to be extremely significant (p<0.00001).
Conclusion: Practice of Nadishodhana Pranayama significantly improves the efficiency of performance of a functional mobility task in stroke patients immediately.
Quantitative Characterization of Postural Sway During
Quiet Stance Under Muscle Fatigue in Healthy Young
Adults
Co- Author: Ishita J Sheth
Click to access ANN.MS.ID.000591.pdf
Usefulness of Toys in Neurodevelopmental disorders-A Survey amongst Physiotherapists
Co- Author: Rucha R Gadgil
Background: Neuromuscular disorders create profound movement disorders in children affecting their development physically and mentally. Considering the challenging circumstances of pediatric population with developmental disorders, therapeutic toys can prove to be beneficial in therapy in achieving both functional goals and psychological goals. This study aimed to assess Physiotherapists’ knowledge of use of therapeutic toys as an approach in therapy of children with developmental disabilities.Method: A semi-structured, self-administered questionnaire prepared on Google Forms was circulated among physiotherapists having experience in pediatric physiotherapy via social media. Data analysis was done by Google spreadsheet.Results: 102 physiotherapists responded. 99% were using toys with 80% using them constructively. 38% reported they did not know the impairments that can be targeted and properties that could be useful. 56% said there was no evidence of toys in therapy.
Conclusion: Awareness regarding therapeutic use of toys is required in pediatric physiotherapists
Impact of Cognitive Impairments on Functional Ambulation in Stroke Patients
Background: Regaining the ability to walk independently is the most important functional goal in rehabilitation of stroke patients. Cognitive impairments are increasingly recognized as affecting functional outcome in stroke. The purpose of this study was to determine the association between cognition and functional ambulation level in chronic stroke patients.
Methods:
Design: Cross-sectional, observational
Setting: Tertiary care centre, Mumbai, India Participants: 60 ambulatory post-acute stroke patients Main outcome measures: • Cognition was assessed using Montreal Cognitive Assessment (MoCA) scale • Functional ambulation level was determined using Modified Hoffer functional ambulation classification (FAC). Results: The prevalence of cognitive impairments was 46%. According to FAC, 28.3% of the patients were community walkers. MoCA score discriminated between unlimited household and most limited community walkers (p<0.03) and also between least limited community and community walkers (p<0.04). Conclusion: Community ambulation is significantly limited in chronic stroke patients. Cognitive impairments are prevalent and persistent even after the acute phase. Cognition is an important factor in the attainment of community ambulation in chronic stroke patients. Along with physical impairments, cognitive impairments need to be specifically addressed for successful rehabilitation outcome in stroke.
Can Quantitative Balance Measures Discriminate between Functional
Ambulation Categories in Chronic Stroke Survivors?
Background: The limited walking ability that follows a stroke restricts a patient’s independent mobility about the home and community, a significant social handicap. This study investigated the relationship between quantitative balance indices and functional ambulation level in stroke patients. The purpose was to explore whether we could provide supportive laboratory evidence for the association between balance and ambulatory level in stroke patients based on computerized dynamic post urography. Study design: Cross-sectional, observational, descriptive study Setting: Physiotherapy department in a tertiary care center in Mumbai Participants: 40 ambulatory stroke patients (mean age=54.07 ± 11.9 years) Main outcome measures: (1) Static and dynamic balance was assessed using computerized force plate system (2) Functional ambulation level was determined using Modified Hoffer functional ambulation classification (FAC). Results: According to FAC, 29.26% of the patients were community walkers. One way ANNOVA showed that static and dynamic balance indices were significantly different with functional ambulation categories. Weight bearing asymmetry during quiet stance (p<0.04); COG sway velocity (p<0.04), weight transfer time (p<0.04) and rising index (p<0.02) during sit to stand can discriminate between household and community ambulators. Conclusion: Balance is a significant factor in the attainment of independent functional ambulation in chronic stroke patients. The functional mobility capability of stroke patients may be quantified analytically using static and dynamic balance indices. The key balance factors identified through this study need to be specifically targeted for training and as outcome measures while monitoring the progress of patients through different functional ambulation categories. Results of this study offer a quantitative method of relating the social disadvantage of stroke patients to the impairments
Glint 2020 