Effects of A Six-Weeks Balance Training on Balance

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Number 4

October-December 2014

Indian Journal of Physiotherapy and Occupational Therapy EDITOR-IN-CHIEF Archna Sharma Ex- Head. Dept. of Physiotherapy, G. M. Modi Hospital, Saket, New Delhi - 110 017 Email : [email protected] Executive Editor Prof. R K Sharma Dean (R&D), Saraswathi Institute of Medical Sciences, Hapur, UP, India Formerly at All India Institute of Medical Sciences, New Delhi Sub Editor Kavita Behal Sharma MPT (Ortho) INTERNATIONAL EDITORIAL ADVISORY BOARD

NATIONAL EDITORIAL ADVISORY BOARD

1.

Vikram Mohan (Lecturer) Universiti Teknologi MARA, Malaysia

1.

Charu Garg (Incharge PT) , Sikanderpur Hospital (MJSMRS),Sirsa Haryana, India

2.

Angusamy Ramadurai (Principal) Nyangabgwe Referral Hospital, Botswana

2.

Vaibhav Madhukar Kapre (Associate Professor) MGM Institute of Physiotherapy, Aurangabad (Maharashtra)

3.

Faizan Zaffar Kashoo (Lecturer) College Applied Medical Sciences, Al-Majma'ah University, Kingdom of Saudi Arabia

3.

Amit Vinayak Nagrale (Associate Professor) Maharashtra Institute of Physiotherapy, Latur,Maharashtra

4.

4.

Amr Almaz Abdel-aziem (Assistant Professor) of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt

Manu Goyal (Principal), M.M University Mullana, Ambala, Haryana, India

5.

P.ShanmugaRaju (Asst.Professor & I/C Head) Chalmeda AnandRao Institute of Medical Sciences, Karimnagar, Andhra Pradesh

5.

Abhilash Babu Surabhi (Physiotherapist) Long Sault, Ontario, Canada

6.

6.

Avanianban Chakkarapani (Senior Lecturer) Quest International University Perak, IPOH, Malaysia

Sudhanshu Pandey (Consultant Physical Therapy and Rehabilitation) Department \Base Hospital, Delhi

7.

Khatri Subhash Maniklal (Professor & Principal) College of Physiotherapy, Pravara Institute of Medical Sciences, Ahmed Nagar, Maharashtra

8.

Aparna Sarkar (Associate Professor) AIPT, Amity university, Noida

9.

Jasobanta Sethi (Professor & Head) Lovely Professional University, Phagwara, Punjab

7.

Manobhiram Nellutla (Safety Advisor) Fiosa-Miosa Safety Alliance of BC, Chilliwack, British Columbia

8.

Jaya Shanker Tedla (Assistant Professor) College of Applied Medical Sciences, Saudi Arabia

9.

Stanley John Winser (PhD Candidate) at University of Otago, New Zealand

10. Salwa El-Sobkey (Associate Professor) King Saud University, Saudi Arabia 11. Saleh Aloraibi (Associate Professor) College of Applied Medical Sciences, Saudi Arabia 12. Rashij M, Faculty-PT Neuro Sciences College of Allied Health Sciences, UAE 13. Mohmad Waseem, (Exercise Therapist) Alberta- CANADA 14. Muhammad Naveed Babur (Principle & Associate Professor) Isra University, Islamabad, Pakistan 15. Zbigniew Sliwinski (Professor) Jan Kochanowski University in Kielce 16. Mohammed Taher Ahmed Omar (Assistant professor) Cairo University, Giza, Egypt 17. Ganesan Kathiresan (DBC Senior Physiotherapist) Kuching, Sarawak, Malaysia 18. Kartik Shah (Health Consultant) for the Yoga Expo, Canada 19. Shweta Gore (Senior Physical Therapist) Narayan Rehabilitation, Bad Axe, Michigan, USA 20. Ashokan Arumugam (PhD Candidate School of Physiotherapy) University of Otago,,Dunedin, New Zealand 21. Dr. Abdel Hameed Nabil Deghidi (Lecturer) Dept. of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University Majmaah, KSA

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10. Patitapaban Mohanty (Assoc. Professor & H.O.D) SVNIRTAR, Cuttack, Odisha 11. Suraj Kumar (HOD and Lecturer) Physiotherapy Rural Institute of Medical Sciences & Research, Paramedical Vigyan Mahavidhyalaya Saifai, Etawah,UP 12. U.Ganapathy Sankar (Vice Principal) SRM College of Occupational Therapy, Kattankulathur,Tamil Nadu 13. Hemant Juneja (Head of Department & Associate Professor) Amar Jyoti Institute of Physiotherapy, Delhi 14. Sanjiv Kumar (I/C Principal & Professor) KLEU Institute of physiotherapy, Belgaum, Karnataka 15. Shaji John Kachanathu (Associate Professor) Jaipur Physiotherapy College, Rajasthan, India 16. Narasimman Swaminathan (Professor, Course Coordinator and Head) Father Muller Medical College, Mangalore 17. Pooja Sharma (Assistant professor) AIPT, Amity university, Noida 18. Nilima Bedekar (Professor, HOD) Musculoskeletal Sciences, Sancheti Institute College of Physiotherapy, Pune. 19. N.Venkatesh (Principal and Professor) Sri Ramachandra university, Chennai 20. Meenakshi Batra (Senior Occupational Therapist), Pandit Deen Dayal Upadhyaya Institute for The Physically Handicapped, New Delhi 21. Shovan Saha, T (Associate Professor & Head) Occupational therapy School of allied health sciences,Manipal university,Manipal,, karnataka,

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Indian Journal of Physiotherapy and Occupational Therapy NATIONAL EDITORIAL ADVISORY BOARD

SCIENTIFIC COMMITTEE

21. Akshat Pandey (Sports Physiotherapist) Indian Weightlifting Federation/ Senior Men and Woman / SAI NSNIS Patiala

1.

23. Dr. Jagatheesan A (HOD-Paediatric Physiotherapy & Associate Professor) Saveetha College of Physiotherapy, Thandalam, Chennai

2. 3.

24. Maneesh Arora (Professor and as Head of Dept) Sardar Bhagwan (P.G.) Institute of Biomemical Sciences, Balawala, Dehradun, UK

4.

25. Jayaprakash Jayavelu (Chief Physiotherapist) Medanta The Medicity, Gurgaon Haryana

5.

26. Deepak Sharan (Medical Director and Sole Proprietor) RECOUP Neuromusculoskeletal Rehabilitation Centre, New Delhi

6. 7. 8.

27. Vaibhav Agarwal (Incharge, Dept of Physiotherapy) HIHT, Dehradun 28. Shipra Bhatia (Assistant Professor) AIPT, Amity university, Noida

9. 10.

29. Jaskirat Kaur (Assistant Professor) Indian Spinal Injuries Center, New Delhi

11.

30. Prashant Mukkanavar (Assistant Professor) S.D.M College of Physiotherapy, Dharwad, Karnataka

12.

31. Chandan Kumar (Associate Professor & HOD) Neurophysiotherapy, Mahatma Gandhi Mission's Institute of Physiotherapy, Aurangabad, Maharashtra 32. Dr. Kshitija Bansal (Assistant Professor) Amar Jyoti Institute of Physiotherapy University of Delhi

13. 14. 15.

33. U Albert Anand (Professor), Physical Therapy Education and Research, Senior Physiotherapist, KG Hospital and K.G College of Physiotherapy, Coimbatore, Tamilnadu, India

16.

34. Dr. M G Mokashi (Professor Emeritus), Physiotherapy, Dr. D Y Patil University, Pimpri, Pune

17.

35. Dr. Balaji.G (Professor and Research Coordinator), Krupanidhi College Of Physiotherapy, Bangalore

18.

Gaurav Shori (Assistant Professor) I.T.S College of Physiotherapy Baskaran Chandrasekaran (Senior Physiotherapist) PSG Hospitals, Coimbatore Dharam Pandey (Sr. Consultant & Head of Department) BLK Super Speciality Hospital, New Delhi Jeba Chitra (Associate Professor) KLEU Institute of Physiotherapy Belgaum, Karnataka Deepak B.Anap (Associate Professor) PDVPPF's, College of Physiotherapy, Ahmednagar. ( Maharashtra) Shalini Grover (Assistant Professor) HOD-FAS,MRIU Vijay Batra (Lecturer) ISIC Institute of Rehab. Sciences Ravinder Narwal (Lecturer) Himalayan Hospital, HIHIT Medical University, Dehradun-UK. Abraham Samuel Babu (Assistant Professor) Manipal College of Allied Health Sciences, Manipal Anu Bansal (Assistant Professor and Clinical Coordinator) AIPT , Amity university, Noida Bindya Sharma (Assistant Professor) Dr. D. Y. Patil College Of Physiotherapy, Pune Dheeraj Lamba (Lecturer) Institute of Allied Health (Paramedical) Services, Education & Training (IAHSET) Govt. Medical Soumya G (Assistant Professor) (MSRMC) Nalina Gupta Singh (Assistant Professor) Physiotherapy, Amar Jyoti Institute of Physiotherapy, University of Delhi Gayatri Jadav Upadhyay (Academic Head) Academic Physiotherapist & Consultant PT, RECOUP Neuromusculoskeletal Rehabilitation Centre, Bangalore Nusrat Hamdani ( Asst.Professor and Consultant) Neurophysiotherapy (Rehabilitation Center, Jamia Hamdard) New Delhi Ramesh Debur Visweswara (Assistant Professor) M.S. Ramaiah Medical College & Hospital, Bangalore Nishat Quddus (Assistant Professor) Jamia Hamdard, New Delhi

“Indian Journal of Physiotherapy and Occupational Therapy” An essential indexed peer reviewed journal for all physiotherapists & occupational therapists provides professionals with a forum to discuss today’s challenges- identifying the philosophical and conceptual foundations of the practice; sharing innovative evaluation and treatment techniques; learning about and assimilating new methodologies developing in related professions; and communicating information about new practice settings. The journal serves as a valuable tool for helping therapists deal effectively with the challenges of the field. It emphasizes articles and reports that are directly relevant to practice. The journal is now covered by INDEX COPERNICUS, POLAND and covered by many internet databases. The Journal is registered with Registrar of Newspapers for India vide registration number DELENG/2007/20988 Print-ISSN: 0973-5666, Electronic - ISSN: 0973-5674, Frequency: Quarterly (4 issues per volume).

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Editor Archna Sharma Institute of Medico-legal Publications 4th Floor, Statesman House Building, Barakhamba Road, Connaught Place, New Delhi-110 001 Printed, published and owned by Archna Sharma Institute of Medico-legal Publications 4th Floor, Statesman House Building, Barakhamba Road, Connaught Place, New Delhi-110 001 Design & Printed at M/s Vineeta Graphics, B-188, Subash Colony, Ballabgarh, Faridabad Published at Institute of Medico-legal Publications 4th Floor, Statesman House Building, Barakhamba Road, Connaught Place, New Delhi-110 001

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

Contents Volume 08 Number 04

October-December 2014

1.

Modifications in Homes of the Geriatric Population to Improve Quality of Life .............................................................. 01 Ashutosh Kurtkoti

2.

Comparative Study of Short Term Response between Maitland Mobilization and ......................................................... 06 Mulligan's Mobilization with Movement of Hip Joint in Osteoarthritis of Knee Patients Identified as Per Clinical Prediction Rule Ajit Dabholkar, Sneha Kumari, SujataYardi

3.

Correlation of Balance Performance and Fear of Fall in Parkinson's Disease ..................................................................... 11 Avani Desai, Vivek Kulkarni, Nimisha Mishra, SavitaRairikar, AshokShyam, ParagSancheti

4.

A Study on Co-Relationship between Static Back Extensor Endurance in Patients .......................................................... 16 with Non-Specific Chronic Low Back Pain and Healthy Individual Paras Bhura, Camy Bhagat

5.

To Compare the effect of Task Oriented Intervention and Treadmill Training to ............................................................. 21 Improve Gait in Chronic Ambulatory Hemiparetic Stroke Patients Monika Sharma, Dharam Pani Pandey

6.

Effect of Muscle Energy Technique to Improve Flexibility of Gastro-Soleus Complex in ................................................ 26 Plantar Fasciitis: A Randomised Clinical, Prospective Study Design Rahul Tanwar, Monika Moitra, Manu Goyal

7.

Effect of Muscle Energy Technique to Improve Flexibility of Gastro-Soleus Complex in ................................................ 31 Plantar Fasciitis: A Randomised Clinical, Prospective Study Design Sharma S, Saini S, Kaprail M, Dhillon PK, Benjamin KE, Saini P

8.

A Comparative Study of Static Stretch and Proprioceptive Neuromuscular Facilitation ................................................. 37 (PNF) Stretch on Pectoral Muscle Flexibility Vohra Ramneesh, Kalra Sheetal, Yadav Joginder

9.

Effect of Muscle Energy Technique and Deep Neck Flexors Exercise on Pain, Disability and ........................................ 43 Forward Head Posture in Patients with Chronic Neck Pain Narang Sakshi, Mehra Suman, Sikka Geetanjali

10. Application of TENS on Acupoints as an Important Adjunctive Tool with Task-Related ............................................... 49 Training in Stroke Rehabilitation Program- A Case Study Manoj Kumar Deshmukh, Manu Goyal, Yogita Verma 11. Effect of Progressive Resisted Exercise on Strength, Endurance and Balance on .............................................................. 54 Older Adults above 60 Years Hetal Jain

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II 12. Lumbar Stabilization Exercises on Pain, Disability and Endurance in Patients with and ................................................ 60 Without Lumbosacral Belt in Mechanical Low Back Pain Neha Gulati, Monika Moitra, Manu Goyal 13. Effectiveness of Physiological Cost Index and Gait Parameters in Conventional ............................................................. 66 Versus Ultramodern Prosthesis in Unilateral Transtibial Amputees -A Comparitive Study Shivananda V, Syed Yakub, Nidhin Jose, Sasidhar 14. Nerve Conduction Studies of Upper Extremity in Badminton Players ............................................................................... 72 Manish Dhabliya, Twinkle Y Dabholkar, Sujata Yardi 15. Correlation of Transverses Abdomonis Strength and Endurance with .............................................................................. 77 Pulmonary Functions in Healthy Adults Gotmare Neha, Nagarwala Raziya, Ghodke Aditi, Rairikar Savita, Shyam Ashok, Sancheti Parag 16. A Study on the effectiveness of Plyometric -Weight Training on Anaerobic Powerand .................................................. 82 Muscular Strength in Athletes Sathish Gopaladhas, Elanchezhian Chinnavan, Dhayanidhi Rajaram 17. Effect of Complete Decongestive Therapy (Cdt) in Upper Limb Lymphedema ................................................................ 87 in Breast Cancer Patients Mullai Dhinakaran, Kunal Jain, K E Benjamin, ParamdeepKaur, Dhinakaran 18. Effects of Early Mobilization Combined with Conventional Physiotherapy Treatment .................................................. 92 After 4 Hrs of Lobectomy on Haemodynamics, Abg and Pft Mohammad Qasim, Jyoti Jalwan, R K Dewan 19. Comparison of Active Cycle of Breathing and High-Frequency .......................................................................................... 97 Oscillation Jacket in Bronchiectasis Patient Manish P Shukla, Vaibhav M Kapre 20. Injury Management and Return-To-Play: Practices in India ............................................................................................... 102 Nandakumar T R MPT, Jaspal Singh Sandhu MS 21. Effect of Music Intervention on Immediate Post Operative Coronary Artery .................................................................. 106 Bypass Graft Surgery (CABG) Patients ShwetaS DevarePhadke, HadiyaParkar, SujataYardi 22. Compare the effectiveness of Massage Versus Cryotherapy in Treating .......................................................................... 112 Delayed Onset Muscle Soreness Sai Deepthi Yarlagadda, M Seshagiri Rao 23. A Study of Common Impairements Following Modified Radical Mastectomy ............................................................... 117 Kinjal D Raja, U S Damke, S Bhave, M M Kulsange 24. Effects of A Six-Weeks Balance Training on Balance Performance and ............................................................................ 123 Functional Independence in Hemiparetic Stroke Srvivors Caleb Ademola Gbiri, Aishat Shittu 25. Effect of Swiss Ball Training on Balance in Hemiplegic Patient ......................................................................................... 128 Preeti Gazbare, Tushar Palekar 26. Role of Physiotherapy in Public Health Domain: India Perspective .................................................................................. 134 Kirti Sundar Sahu, Bhavna Bharati

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III 27. Effect of Joint Approximation through Weights Around Waist on ................................................................................... 138 Postural Sway and Balance in Elderly Neetu Rani Dhiman, Sunil Bhatt, Vyom Gyanpuri, Girdhari Lal Shah 28. Effectiveness of Tailor Made Exercise Intervention for Low Back Pain and ..................................................................... 143 Pelvic Pain during Pregnancy - A Randomized Controlled Trial Arati Mahishale, Shobhana Patted 29. A Study to Correlate Various Anthropometric Measures on Excursion Distances while .............................................. 149 Performing on the Star Excursion Balance Test among Amateur Sports Person - A Cross Sectional Observational Study Krishna D Desai, Hardik Trivedi 30. Return to Run: Lateral Ankle Sprain with Sural Nerve Involvement - A Case Study .................................................... 156 Jacob Praveen Jayamoorthy 31. Prevalence of Neck or/and Low Back Pain and Associated Risk Factors in Sidcul ........................................................ 162 Industrial Area, Rudrapur, Uttrakhan Sunil Bhatt, Prabhjot Kaur 32. A Study to Compare the effectiveness of Different Dosage of Therapeutic Ultrasound on ........................................... 168 Pain and Grip Strength in Patients with Lateral Epicondylitis Mittal Hareshbhai Shanishwara, Ashish Kakkad 33. Effect of Slump Stretching with Static Spinal Exercise for the Management of Non ...................................................... 175 Radicular Low Back Pain among Non Active Sports Persons Karthikeyan, Jaihind jothikaran, Pradeep Kiran 34. A Cor-Relational Study Between Carpal Tunnel Syndrome Questionnaire and Nerve ................................................. 180 Conduction Study in Computer Operators Hemal Paneri, Sarla Bhatt 35. Effect of Body Weight Squatting on Functional Independence in the Individuals with ................................................. 186 Incomplete Spinal Cord Injury Disha Solanki 36. Effecacy of Backwardwalking on Patient with Osteoarthritis of Knee on Quadriceps ................................................... 192 Strength, Pain and Physical Functions Manisha Rathi, Tushar Palekar, Anjumol Varghese 37. A Comparative Study to Find out the Calcaneal Eversion in Overweight and Normal Individuals ........................... 197 Hemal Paneri, Sheshna Rathod, Disha Solanki 38. Effect of Cryotherapy on the Intrinsic Muscle Strength of the Hand ................................................................................ 202 Himanshu Mohan Pathak 39. A Comparative Study between Taping and Medial Arch Support on EMG Activity ..................................................... 207 of Selected Foot Muscles in Individuals with Flexible Flat Foot Dabie Wu, Navin Daniel Raj 40. Comparison of Flow and Volume Oriented Incentive Spirometry on Lung Function and ............................................ 214 Diaphragm Movement After Laparoscopic Abdominal Surgery. A Randomized Clinical Pilot Trial Gopala Krishna Alaparthi, Alfred Joseph Augustine, Anand R, Ajith Mahale

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IV 41. Effect of Treadmill Training on Gait and Balance Impairments in Patients with Parkinson's Disease ........................ 219 Nimisha Mishra, Vivek Kulkarni, Savita Rairikar, Ashok Shyam, Parag Sancheti 42. A Study to Compare efficacy of Taping Technique Versus Calcaneum Glide ................................................................. 224 Mobilization for the Treatment of Planter Fasciitis Mayur Solanki 43. Comparison of Sit and Reach Test, Back Saver Sit and Reach Test and Chair Sit and Reach ........................................ 230 Test for Measurement of Hamstring Flexibility in Female Graduate and Undergraduate Physiotherapy Students Garima Wadhwa, Chaya Garg 44. Prevalence of Post Polio Syndrome in Gujarat and the Correlation of Pain and ............................................................. 235 Fatigue with Functioning in Subjects with Post Polio Syndrome Megha Sandeep Sheth, Srishti Sanat Sharma, Rajesh Jadav, Bhaskar Ghoghari, Neeta Jayprakash Vyas 45. A Study of Neck Pain and Role of Scapular Position in Computer Professionals .......................................................... 241 Jyoti Dahiya, Savita Ravindra 46. Efficacy of Maitland's Spinal Mobilizations Versus Mckenzie Press-Up Exercises on ................................................... 247 Pain, Range of Motion and Functional Disability in Subjects with non Radiating Acute Low Back Pain Arpit Sheth, Anu Arora, Sujata Yardi 47. Effect of Breathing Exercises on Lung Functions in Postpartum Mothers with Normal Vaginal Delivery ................. 253 Amrita L Tomar, Manisha A Rathi 48. Impact of Simultaneous Feedback Augmentation and Real Time Treadmill ................................................................... 258 Training on Gait in Diplegic Childre Ragab Kamal Elnaggar 49. Relative & Cumulative efficacy of Auditory & Visual Imagery on Upper Limb ............................................................... 64 Functional Activity among Chronic Stroke Patients Fuzail Ahmad, Sami Al-Abdulwahab, Nasser Al-Jarallah, Raidah Al-Baradie, Mohammad Z Al-Qawi, Faizan Z Kashoo, Harpreet S Sachdeva 50. Effect of Dexamethasone Iontophoresis Combined with Strong Surged Faradic ............................................................ 270 Current on Piriformis Syndrome -A Simple Randomized Control Clinical Trail FGowrishankar Potturi, A N Sundaresan, J Mahendran, P D Karthikeyan, V KrishnaReddy 51. Effect of Ageing on Lumbar Curvature, Lumbar Mobility, Back Extensor Strength and ............................................... 276 Their Relationship with Postural Stability and Clinically Relevant Low Back Pain Mohammad Rehan Asad, Khwaja Mohammad Amir, Fahim Haider Jafari, Mohamed Taha, Waqas Sami 52. A Study to Identify Responses to Sensory Events in Daily Life in Children with ........................................................... 282 ADHD & Typical Developing Children among Indian Population U Ganapathy Sankar, Kotharu Akhila 53. Comparison of Incentive Spirometry V/S Peak Flow Meter by Measuring the .............................................................. 288 Peak Flow Rate in Post Operative Abdominal Surgery Patients Apeksha O Yadav 54. Effect of Passive Vibration on Skin Blood Flow in Persons with Good Glycemic ........................................................... 293 Control and Poor Glycemic Control Type 2 Diabetes Kanikkai Steni Balan Sackiriyas, Everett B Lohman, Noha S Daher, Lee S Berk, Rafael Canizales, Ernie Schwab

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DOI Number: 10.5958/0973-5674.2014.00344.X

Modifications in Homes of the Geriatric Population to Improve Quality of Life Ashutosh Kurtkoti Asst. Professor, CMF's College of Physiotherapy, Nigdi, Pune

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ABSTRACT Introduction & Purpose: Older people are often not aware about healthcare and lack scientific knowledge about the home modifications, rehabilitation and the place of living. So in order to study the basis geriatric problems with respect to their living place and the mentality of care givers for acceptance of home modifications, a specially designed study was needed. Aim: To assess the homes to find out environmental barriers and to check the readiness of the people to modify them. Objectives: To assess the homes of geriatrics for potential environmental barriers, to suggest the home modifications and check readiness of the people for home modifications and check which area is of home people are keener to modify to prevent falls. Methodology: Study design is descriptive study and sample population taken was geriatric people in PCMC area with sample size of 100 (50 first visit, 50 second visit). Simple random sampling method was used. Healthy elders living in homes with family were included in the study. Survey was done in living room, bed room, kitchen, bathroom, and stairs of house, then questionnaire based assessment was done & required modifications were suggested, in the second visit it was checked whether the people have done the modifications or not & which is the most common area of the house for barriers, and people are keener to modify. Pre & post questionnaire survey was used as an outcome measure. Result: The data was analyzed using descriptive statistics at Level of significance (? ) 5 % ( p value 0.05) & Degree of freedom 1. Out of 50, 40 homes have done suggested home modifications i.e. 80% and 10 homes have not done home modifications i.e. 20 %, Maximum people have done modifications in toilet/bathroom (24%) followed by living room (21%), stairs (20%), kitchen (19%) and bedroom (16%). Conclusion: People have willingness to do home modifications. Bathroom/toilet is found to be the most concerned area of home where maximum home barriers are found and modifications are done. Clinical Significance: we can check the home hazards & suggest appropriate modification so that rehabilitation will have a clinical along with an added community level approach. Keywords: Geriatrics, Home Modifications, Home Hazards/Barriers

INTRODUCTION Approximately 20-55 percent of all unintentional falls and fall-related injuries in adults over the age of 60 years occur inside the home. Most falls (44 percent) occur on a level surface (e.g. ground level), 16 percent occur on the stairs or from a height, and 4 percent occur

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in the bathroom. Approximately 75 percent of these falls happen during the performance of routine daily activities, 44 percent occur in the presence of one or more environmental hazards and 2 to 5 percent during the performance of hazardous activities, such as climbing onto ladders.(1) Only 20 percent of older adults

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who fall seek medical attention therefore, the full extent of falls and injuries is unknown. The result of unintentional falls can have a negative effect on quality of life, including loss in days of work, increased healthcare expenditures, dependency, and early admission to an assisted living or long-term care facility. (4) Preventing falls and disability and maintaining older adults as valuable members of their communities is rapidly becoming a national priority. This major public healthcare concern not only encompasses the physical and psychological squeal associated with the fall itself, but also the social and economic impact on the individual, family/caregivers, and the healthcare industry. (2) Recently published guidelines include home hazard and safety assessment and home modification as part of fall prevention for adults over the age of 65 years. The purposes of this study is to highlight findings from selected research studies and identify components of a home hazard and safety modifications and level of acceptance for home modifications as part of a geriatric assessment for older adults living at home. (5) Home modifications include five basic services that directly support independent living (Steinfeld. 1981) (9) (17) •

Security improvements such as improving locks, outdoor lighting, securing windows,



Fire safety improvements such as eliminating overloaded electrical circuits and installing smoke detectors,



Accident prevention measures, including repairing stairways, improved lighting, and repair of floor surfaces,



Accessibility and usability modifications including construction of entry ramps, installation of grab bars and adapting round door knobs with levers,



Construction related services such as emergency repairs, weatherization, maintenance and general rehabilitation.

Home modifications help you to improve the quality of life of elderly people that provide independence and dignity of life for the elderly. Accessible housing doesn’t simply mean a house with a ramp or lift anymore. Today, the concept of universal design extends to all—old, young, tall, short, disabled. Today’s contemporary values require personal

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comfort at the least—not just for people with disabilities! Words like “barrier free” and “ergonomic” are now part of the common vocabulary. (3) (9) Older people are often neglected in research (in INDIA) also in the health care and in scientific knowledge about medical treatment and the place of living. Aim & objectives of the study is to assess the homes to find out environmental barriers and to check the readiness of the people to modify them and to check which area of home people are keener to modify to prevent falls and to improve the quality of life of their elderly. MATERIALS AND METHOD Consent to carry out the study was granted by the institutional ethical clearance committee. All subjects signed the required consent before beginning the study. 50 subjects aged above Geriatric people above 60 years of age with No diagnosed health problems, Males and females randomly selected. Any fracture, Geriatric people with vascular disease, stroke, neuromuscular disease etc, Visual impairment problems, Sensory impairment, congenital abnormalities were excluded. Data is taken from the corporation (PimpriChinchwad, Maharashtra, India) about the Age, Sex, Address of the community living elderly, a formal permission is taken from the Chair person of the Society & Residential House owner to do the survey and assessment. A formal Consent form was given to Geriatric people in home. Survey is conducted mainly in five areas like living room, bed room, kitchen, bathroom, and stairs of house. In this we have focused mainly as per table and further intervention for home modification programs was explained and emphasized. A second visit was done to the same house after fifteen days to check whether the people have done the modifications or not. And what is the most common area of the house for barriers, what is the most common problem and people are keener to modify which part of the home to prevent falls and improve independence of geriatrics in home. DATA ANALYSIS The Chi-Square test is known as the test of goodness of fit and Chi-Square test of Independence. In the Chi-

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Square test of Independence, goodness of fit frequency of one nominal variable is compared with the theoretical expected frequency. In the Chi-Square test of Independence, the frequency of one nominal variable is compared with different values of the second nominal variable.

Graph 2: Modifications done by number of families in different areas of the home

RESULTS Out of 50, 40 homes have done suggested home modifications i.e. 80% and 10 homes have not done home modifications i.e. 20 %. Maximum people have done modifications in toilet/bathroom (24%) followed by living room (21%), stairs (20%), kitchen (19%) and bedroom (16%). Obstacles in the pathway (26 homes) is the most common home barrier found in the living room followed by curled carpet edges (13 homes), improperly marked light switched (10 homes) and dim lighting (7 homes). Improper placement of frequently used items is the most common barrier found in kitchen (17 homes) followed by improperly marked light switched (16 homes) and dim lighting (15 homes) and obstacles in the pathway (9 homes). Light switches were not clearly marked in majority of the bedrooms (14 homes) followed by wrong placement of frequently used items needing frequently reaching or bending (9 homes), non sturdy furniture (8 homes) and obstacles in the pathway (8). Slippery area is the most common home barrier found in bathroom/toilet (28 homes) with equal prevalence of dim light (20 homes) and low toilet seat (20 homes) and absence of grab bars (17 homes). Most common home barrier found in stairs is the damaged or unequal steps (23 homes) followed by dim light (20 homes), absence of hand rails (13homes), and not clearly marked light switches (2 homes). Graph 1: Analysis of overall modification

Interpretation: 80% people have done home modifications and 20% have not done.

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Interpretation: Maximum people have done modifications in toilet/bathroom followed by living room, stairs, kitchen and bedroom.

DISCUSSION In this study we have evaluated the homes of geriatric people in the form of observation method and then interviewed the elderly and the care giver together to ask them whether the home barriers we have found are troublesome for them or not. If yes then what do they think about home modifications? A thorough survey is done of all the areas of home mainly living room, bedroom, kitchen, toilet/bathroom and stairs to find the potential home hazards. Also to check that which the area of home is where the geriatric people face maximum difficulty to perform their activities of daily lining (ADL’S). The various home modifications suggested by therapist in different areas of home are as follows: KITCHEN: The doorway must be a minimum of 36 inches wide - measure the width of your chair so you’ll know what you have. Rather than paying for a new doorway to be cut and rebuilt, remove the door and its hinges, molding or threshold. If the only way into the kitchen is up or down stairs, it may be possible to ramp it if it’s not too steep. Electrical outlets and light switches can be easily relocated by an electrician and lighting can be enhanced by marking it clearly, adding track or overhead fixtures, or a portable desk lamp on the counter. Since cabinets are expensive to replace, removing a cabinet door below the sink or counter will provide knee space so you can work from a seated position. Just remember to insulate the pipes below the sink to prevent scalding legs. Store

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4 Indian Journal of Physiotherapy & Occupational Therapy. October-December 2014, Vol. 8, No. 4

cabinet doors in a safe place with their hardware taped to them. (18) It may be necessary to replace the cabinets with lower ones. Although costly, this may be all you need to make the kitchen useable. Vertically adjustable models can be raised and lowered; roll-out shelves are much more useful within any cabinet. Cabinets may also be reinstalled higher to accommodate someone tall or unable to bend down. A platform is the most versatile option, especially when the space below is kept free for leg space, rather than putting a cabinet there to store pots and pans. The floor must be kept dry and free of obstacles in the pathway. Adequate illumination. Frequently used items should be kept in easy reach. (6) (20) BATHROOM & TOILET: Frequently used items like soap, towel, scrubber, etc can be raised for their height if someone is having difficulty bending over or lowered to accommodate a seated person. If one has several people living in the home, decide on a compromised height. Toilet height is also important. If the toilet seat is too low, it’s difficult for many people to lower themselves down up to the seat or to get up back from the seat. This can be remedied with portable toilet seats. (9) (11) Many different styles and types of toilets are available, along with safety straps and other aids. A hand-held shower will bring the water down to a comfortable level. It’s also possible to install a stand or adjustable pole to free up the bather’s hands. When skin has decreased sensitivity, an anti-scald device should also be installed in both the shower and bathroom sink. (8) Entrance Exit & Doorways: A doorway must be at least 36 inches wide. Doorstops can be removed, as well as thick thresholds that are difficult to roll over. If bathroom doors are the narrowest; a curtain or decorative screen will provide privacy, as well as access to the room. Locks on doors can be lowered for a person in a wheelchair to comfortably reach it. Avoid thick doormats, like the contemporary bristly-style mats. Older people may trip over them and they’re hazardous to persons with walking difficulties, and persons with visual impairment. A thin, rubber mat is safer and still traps some dirt and moisture. (7) (12) Living Room: The height of the furniture should custom made means it should be made according to the alderfly’s convenience so that they should not have trouble in sitting & getting up. Floor should be kept dry. Preferably antiskid mat should be used. Carpet edges should not be curled up. Adequate lighting should be done. (11)

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Stairs: All steps should have equal height, Proper illumination is also a must, Hand railing throughout the length of the staircase should be present, No obstacles in the pathway. (10) CONCLUSION People have willingness to do home modifications. Bathroom/toilet is found to be the most concerned area of home where maximum home barriers are found and modifications are done followed by living room, stairs, kitchen and bedroom. ACKNOWLEDGMENTS: I am thankful to my Guide Dr. Tushar Palekar, for his valuable guidance. I am also thankful to all my subjects, who were essential part of the project. Conflicts of Interest: None Source of Funding: None Ethical Clearance: Ethical clearance was obtained from Ethical committee, Padmashree Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune 411018. REFERENCES 1. 2.

3.

4.

5.

6.

Garson LW, Cameron CA Jar, Wilber ST. Home modification to prevent falls by older ED patients. Am J Emerge Med 2005; 23:295-298. Stevens M, Holman CD, Bennett N. Preventing falls in older people: Impact of an intervention to reduce environmental hazards in the home. J Am Geriatric Soc 2001; 49:1442-1447 Northridge ME, Levitt MC, Kelsey JL, Link B. Home hazards and falls in the elderly: The role of health and functional status. Is J Public Health 1995; 85:509-515? Gill TM, Williams CS, Tinette ME. Assessing risk for the onset of functional dependence among older adults: the role of physical performance. JAm Geriatric Soc. 1995; 43:603-609. Gill TM, Richardson ED, Tinetti ME. Evaluating the risk of dependence in activities of daily living among community-living older adults with mild to moderate cognitive impairment. J Gerontology Med Sci. 1995; 50:M235-M241. Gill TM, Williams CS, Richardson ED, Tinetti ME. Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons. J Gerontology Med Sci. 1996; 51:M283M288.

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Cumming RG, Thomas M, Szonyi G, et al. Adherence to occupational therapist recommendations for home modifications for falls prevention. Am J Occup Ther 2001; 55(6): 641-648. Ostroff, E., 1989. A Consumer’s Guide to Home Adaptation. (Available from the Adaptive Environments Center, 374 Congress St., Suite 301, Boston, MA 02210. Pynoos, J., 1988. Home Modification for Frail Older Persons: Policy Barriers and New Directions. Paper presented at the meeting of the National Conference on Low-Income Older Homeowners, sponsored by the American Association of Retired Persons. Pynoos, J., in press. “Home Modification and Repair.” In A. Monk, ed., Columbia Handbook on Retirement. New York: Columbia University Press. Pynoos, J. and Cohen, E., 1990. Home Safety Guide for Older People: Check It Out / Fix It Up. Washington, D.C.: Serif Press. Pynoos, J., Cohen, E. and Lucas, C., 1988. The Caring Home Booklet: Environmental Coping Strategies for Alzheimer’s Caregivers. Los Angeles: Long Term Care National Resource Center at UCLA/USC. Pynoos, J. et al., 1987. “Home Modification: Improvements That Extend Independence.” In V. Regnier and J. Pynoos, eds., Housing the Aged: Design and Directives and Policy Considerations.

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New York: Elsevier Science Publishing Co., pp. 277-303. Pynoos, J. et al., in press. Home Modification Guidebook. Los Angeles: Long Term Care NAtional Resource Center at USC/UCLA. Shekelle P, Maglione M, Chang J, et al. Evidence report and evidence-based recommendations: Falls prevention interventions in the Medicare population. Baltimore, MD: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services and RAND; 2003. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventions for preventing falls in elderly people. Cochrane Database Sys Rev 2003; 4:CD000340. Physical & Occupational Therapy in Geriatrics 2000, Vol. 16, No. 3-4, Pages 79-99 , DOI 10.1080/ J148v16n03_05 Carter SE, Campbell EM, Sanson-Fisher RW, Redman S, Gillespie WJ. Environmental hazards in the homes of older People. Age Ageing 1997; 26: 195–202. Connell BR, Wolf SL. Environmental and behavioral circumstances associated with falls at home among healthy individuals. Arch Phys Med Rehabil 1997; 78: 179–86. Josephson KR, Fabacher DA, Rubenstein LZ. Home safety and fall prevention. Clin Geriatric Med 1991; 7: 707–31.

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DOI Number: 10.5958/0973-5674.2014.00344.X 6 Indian Journal of Physiotherapy & Occupational Therapy. October-December 2014, Vol. 8, No. 4

Comparative Study of Short Term Response between Maitland Mobilization and Mulligan's Mobilization with Movement of Hip Joint in Osteoarthritis of Knee Patients Identified as Per Clinical Prediction Rule Ajit Dabholkar1, Sneha Kumari2, SujataYardi3 Associate Professor, MPT, Professor and Director, Department of Physiotherapy, Pad. Dr. D.Y. Patil University, Nerul, Navi Mumbai

1

2

3

ABSTRACT Background and Purpose: Research suggests that many patients with knee osteoarthritis (OA) have hip impairments. A study demonstrated that subjects with knee OA had favourable outcome following a single intervention of hip mobilizations. With a Clinical Prediction Rule (CPR) various components are combined to determine the diagnosis, prognosis, or likely response to treatment of that individual. Thus the purpose of this study is to compare the short term response between Maitland mobilization and Mulligan's Mobilization with Movement (MWM) of hip in osteoarthritis of knee patients identified as per Clinical Prediction Rule. Methodology: An experimental study was done with 60 subjects with OA knee who completed selfreport questionnaires -Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient Specific Functional Scale (PSFS), Numerical Pain Rating Scale (NPRS), underwent clinical examination of the hip and knee, and functional tests. These 60 subjects were divided into 2 groups -Group I received Maitland Mobilization and Group II received Mulligan mobilization. Follow-up testing was completed 2 days later. The reference criterion for determining a favourable response was either (1) a decrease of at least 30% on composite NPRS score obtained during functional tests or (2) a Global Rating of Change Scale (GRCS) score of at least 3. Results: At 48 hour follow-up, 48 subjects (80%) out of 60 - 21(35%) from Maitland group and 27(45%) from Mulligan group were considered to have a favourable short-term response to the treatment. The mean difference in WOMAC, PSFS and NPRS were not statistically significant, whereas GRCS was statistically significant in Mulligan group. Conclusion: Mulligan mobilization of hip was found to be extremely significant than Maitland mobilization in patients with OA knee identified as per CPR. Keywords: Osteoarthritis, Maitland, Mulligan, Clinical Prediction Rule

INTRODUCTION Worldwide estimates are that 9.6% of men and 18.0% of women aged e”60 years have osteoarthritis34.

improved range of motion (ROM), and fewer positive provocative hip test findings following a single intervention of hip mobilizations.

Altered knee function as a result of OA knee may affect the hip and result in painful impairments7.Many patients with knee OA have hip impairments, indicating the need to examine the hip in these patients12.Cliborne et al also demonstrated that subjects with knee OA experienced an average decrease in pain,

30% to 40% of people with knee OA also have hip OA, and it is well known that hip structures can refer pain to the knee1, 23, 35. A CPR consisting of 5 variables was developed by Currier et al 13 for identifying patients with knee pain and clinical evidence of knee OA who will demonstrate a favourable short-term

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response to hip mobilizations. These variables are hip or groin pain or paresthesia, anterior thigh pain, passive hip medial rotation less than 17 degrees, passive knee flexion less than 122 degrees and pain with hip distraction, The number of subjects who benefited from hip mobilizations was substantially larger (68%).Based on the pre-test probability of success (68%), the presence of one variable increased the probability of a successful response to 92% at 48hour follow-up. If 2 variables were present then the probability of success increased to 97%. Clinical prediction rules (CPRs) are tools designed to improve decision making in clinical practice by assisting practitioners in making a particular diagnosis, establishing a prognosis, or matching patients to optimal interventions based on a parsimonious subset of predictor variables from the history and physical examination24,29. Manual therapy techniques like Maitland and Mulligan mobilization are widely used in physiotherapy practice. The responsiveness of this CPR has not been studied on Maitland Mobilization and Mulligan’s MWM .Thus the purpose of this study was to compare the short term response between Maitland Mobilization and Mulligan’s MWM of hip joint in patients with OA knee identified as per CPR. MATERIALS AND METHOD Institutional Ethics Committee approval was taken before the start of the study. 60 subjects with OA knee participated in the study and were divided into two groups : Group I - Maitland mobilization, Group II Mulligan’s MWM The inclusion criteria was based on Altman and colleagues’ criteria2 for diagnosis of OA knee. Subjects were included if they were 50 to 80 years of age, had a primary complaint of knee pain, and met at least 3 of the Altman’s criteria. The exclusion criteria were : Primary complaint of low back pain (LBP); secondary complaint of LBP with pain radiating below the knee; history of cancer; history of hip or knee arthroplasty; Cortisone or synthetic fluid injection to the hip or knee within 30 days of their initial examination; A history of prior treatment with hip mobilization to the involved limb within 6 months of their initial examination; Or any current condition precluding physical therapy intervention (e.g., deep vein thrombosis).For a favourable response to hip mobilization either of the two outcome measures

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should be positive - a decrease of at least 30% on Composite NPRS score obtained during functional tests or a GRCS score of at least 3.Other outcome measures were WOMAC and PSFS. Patients were selected according to the CPR -Hip or groin pain or paresthesia; Anterior thigh pain; Passive knee flexion < 122°; Passive hip medial rotation < 17°;Pain with hip distraction. The procedure involved selecting the patients according to CPR and dividing them into two groups. After the subjects signed an informed consent document, they completed the WOMAC and PSFS, a brief history was taken and physical examination and functional tests were done. The procedure was Physical examination was done for both the limbs. It included : ROM measurements using Universal Goniometer31 for Hip abduction, adduction, extension and Knee flexion ,extension and Universal Inclinometer12,14 for Hip flexion, medial rotation, lateral rotation; Mobility assessment27 of lumbar and lower thoracic spine ;Manual Muscle Testing22 of hip and knee; Hip distraction, Hip Scour, Thomas test, FABERS test. For each of these procedures, subjects were asked to rate their pain from 0 to 10 on the NPRS and describe the pain location. Assessments regarding joint mobility17 .Subjects in Group I was given Maitland Mobilization and Group II subjects were given MWM. 3 sets of 30 seconds with 30 second rest period between the sets of Grade IV of Maitland mobilization was given to Group I. Each subject received 4 hip mobilization procedures: Lateral glide; Caudal glide; Anteroposterior glide (AP); Posteroanterior glide (PA). 3 sets of 10 repetitions with 30 second rest period between the sets of MWM was given to group II. The following instructions were given to be followed at home: Maintain normal daily activities within pain tolerance levels; avoid activities that will exacerbate the symptoms; pain-free hip flexion ROM - 2 sets of 30 seconds in supine position. All subjects were instructed to continue their routine exercises. Follow up was done 48 hours later. At the time of follow up all the subjects completed a final WOMAC, final PSFS and GRCS scales. The same physical examination and functional tests were repeated and associated pain ratings were recorded. The data thus obtained was statistically analysed for the level of significance. Comparison within the groups was done using non parametric test –Wilcoxon test and between groups comparison was done using Mann-Whitney test.

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8 Indian Journal of Physiotherapy & Occupational Therapy. October-December 2014, Vol. 8, No. 4

RESULTS & OBSERVATIONS GROUP

MEAN

SD

P VALUE

Pre WOMAC(Maitland)

116.6

36.43

0.002*

Post WOMAC(Maitland)

110.6

34.33

Pre PSFS(Maitland)

14.73

4.78

Post PSFS(Maitland)

15.6

4.85

Pre Composite NPRS(Maitland)

9.83

4.37

Post Composite NPRS(Maitland)

7.76

4.28

Pre WOMAC(Mulligan)

99.6

36.50

Post WOMAC(Mulligan)

90.46

37.07

Pre PSFS(Mulligan)

16.73

3.140

Post PSFS(Mulligan)

18.6

3.255

Pre Composite NPRS(Mulligan)

9.4

3.25

Post composite NPRS(Mulligan)

5.23

3.32

Mean WOMAC (Maitland)

5.9

8.22

Mean WOMAC (Mulligan)

9.13

6.83

Mean PSFS (Maitland)

-0.93

2.21

Mean PSFS (Mulligan)

-1.86

1.50

Mean COMP NPRS (Maitland)

2.06

4.12

Mean COMP NPRS (Mulligan)

4.16

3.34

GRCS (Maitland)

1.46

2.47

GRCS (Mulligan)

3.03

2.58

0.03* 0.01* 0.05). There was a significant improvement in all the measuring variables within both groups and significant differences between groups in favor of the study group in all outcomes post treatment (p < 0.05). Conclusion: implementation of augmented feedback in gait training program may be effective in improving gait performance in diplegic children. Keywords: Spastic Diplegia, Feedback Augmentation, Gait Parameters

INTRODUCTION Cerebral palsy (CP) is a group of persistent movements and postural disorders caused by unprogressive lesion in the developing immature brain1. Large number of children with CP may have impaired lower Limb (LL) function during standing and walking2. spastic diplegic children are usually independent ambulant but most have an identified gait deviations such as toe walking, semi flexed hips and knees, interiorly tilted pelvis with compensated lumbar hyper lordosis, low walking speed and impaired functional capacity 3.

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Throughout the rehabilitation, physical therapist may impose a walking rhythm upon the child that is not the child own and not self driven by the child so that inadequate motor learning occurs4. So that creating a tangible intuitive interface by using feedback system help to improve the children capabilities and walking practice in cerebral palsied children through the provision of additional support5. Feedback augmentation technologies provide a safe, controlled environment to teach children proper functional motor skills. It provides consistent feedback for motivation and wide ranges of practice6. It creates a virtual context and objects that allow for interactions

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with users7, 8. This technology provides an alternative intervention program for helping to manage functional limitations in children with CP9. Also it provides an exercise environment in which the intensity of practice and positive visual and auditory feedback can be precisely and systematically selected in various nearly natural environments to allow for individualized training in motor learning9, 10. Feedback augmentation is often used as an adjunct to a well established traditional rehabilitation programs to reinforce performance rather than being used as a primary intervention for rehabilitation. The child has to gain in the real time settings to get benefits from the feedback training11. MATERIALS AND METHOD Study Design: This study was a randomized controlled trial. The procedure followed was in accordance with the ethical standards and after the attainment of informed consent from children’s parents or their legal guardian. Subjects: 30 spastic diplegic children were recruited for this study from King Khalid hospital, AlKharj, Saudi Arabia based on the following inclusion criteria. 1) Diplegic children has the ability to self ambulate independently, 2) Their ages ranged from 610 years, 3) Emotional and cognitive state enable the child understanding and cooperation during evaluation and treatment, 4) Free of fixed musculoskeletal deformities in their lower limbs, 5) Informed consents were obtained from the parents or the legal guardian of all children. All participants were assigned to randomly into two groups; control and study group. Both had basically received the same gait training program but the experimental group had additional feedback augmentation using both visual and verbal cues during the training program. Instrumentation: For evaluation, motion analysis system with Vicon Clinical Manager software which consists of: a camera system with twelve cameras for three dimensional gait analyses, a wand kit is used for calibration of system, six meters long walkway with embedded force platform, a computer with installed Vicon Manager Software. For treatment: The system used for training was Zebris Rhawalk Platform System; the system includes an instrumented treadmill with a pressure sensor matrix, a unit for projecting the step pattern within

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the platform, a large screen for projecting the individual virtual feedback training and a processing unit. PROCEDURES For evaluation: Kinematic gait analysis by 3D motion analysis system: step length (cm), step width (cm), velocity (m/min) and angular displacement of hip, knee and ankle during mid stance phase were measured for both groups before and after treatment. Preparing the system includes the following steps: aSetup for the cameras and volume. b- Calibration of the 3D before capture was performed. c- Capture or measurement phase starts, including marker setup and entering subject data (name, age, weight and height) on computer software. The child asked to walk along the walk path on freely chosen speed for a minimum 5-10 walking trials before data collection. d- Export or transfer of the selected gait cycle of the evaluated patient for analysis and obtaining the desired data. When the calculations are completed, the results were displayed showing the calculated global gait parameters. For treatment: The control group received treadmill gait training program with full body weight support conducted for 30 minutes (2 blocks each block is 15 minutes with rest in between) without provision of any external cues in addition to a physical therapy program including, strengthening exercises, standing and walking balance exercise, postural reactions exercises, stretching exercises for 30 minutes The program conducted 3 times per week for three successive months. The study group received the same physical therapy program with augmented visual and verbal feedback during treadmill gait training; each session after familiarization the actual gait parameters recorded by the pressure sensors and 2D cameras connected to the treadmill, the target training parameters on a self selected speed were defined then the training started. The training environment the patient had to follow consisted of a straight walking path through a forest with minimal visual distraction displayed on the screen on the face of the child. The feedback consisted of real time representation of the target parameters by foot projections displayed on both the treadmill and the screen in front of the child and verbal cues from the therapist were used to guide the patient feedback. The treadmill training also was 30

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260 Indian Journal of Physiotherapy & Occupational Therapy. October-December 2014, Vol. 8, No. 4

minutes divided into 2 bouts each one for 15 minutes with time for rest and instruction between bouts in addition to 30 minutes for the other exercise program. Statistical analysis: T-test was conducted to compare the mean differences between both groups pre and post treatment. Paired t test was conducted to compare pre and post treatment mean differences of the outcome measures within each group and unpaired T-test conducted to compare the differences between groups. The level of significance for all

statistical tests was set at p < 0.05. All statistical measures were performed through the statistical package for social studies (SPSS) version 20 for windows. RESULTS The mean ± SD age, weight, and height of control and study groups as shown in table 1 indicates no significant difference between both groups in the mean age, weight, and height (p > 0.05) at the baseline.

Table 1:Age, weight and height of both groups at the baseline. Item

Χ

±SD

p-value

Control

Study

Age

8.050±1.214

7.786±1.168

0.556

Weight

33.867±3.852

34.643±3.835

0.591

Height

134.067±6.363

130.929±7.966

0.250

Measurement data were expressed as mean ± SD. Age (years); Weight (kg) and Height (cm).

Results of the control group: the mean changes in the all outcome measures for the control group pre and post treatment is summarized in Table 2. Results of the outcome measures of spatiotemporal gait assessment and hip, knee and ankle joint displacement showed that there was a significant difference pre and post-treatment in control group (P