Day :
- Physiotherapy
Chair
Inna Mincheva Ivanova,
Medical University of Sofia, Bulgaria
Co-Chair
Shiv Singh Sarangdevot
Janardhan Rai Nagar Rajasthan Vidyapeeth, India
Session Introduction
Brian Wadsworth
NYU Langone Health, USA
Title: Strategies to achieve high intensity gait training in a clinical setting: A Case Study
Biography:
Brian Wadsworth is a Staff Physical Therapist at Rusk Rehabilitation at NYU Langone Health in New York City. He has completed his Residency in Neurologic PT at NYU Rusk between August 2017 and August 2018. He has completed his Graduation at Sacred Heart University with his Doctorate in Physical Therapy in July 2017.
Abstract:
The effectiveness of high intensity gait training (HIGT) is supported in the literature. HIGT is defined as 60- 85% heart rate reserve for 30-40 minutes performed over ground or on the treadmill. Presently, there is limited evidence investigating clinically feasible treatment strategies to achieve HIGT. This case study’s purpose is to identify clinically feasible interventions to achieve HIGT and promote efficient knowledge translation. The patient was a 23-year-old male with C5 incomplete spinal cord injury presenting with left hemiparesis. Interventions incorporated treadmill training (TT) and over ground training (OGT) for a maximum of 60 minutes per session. Strategies included: varying speed; limb weighting; uneven surface gradients; and complex skills training. Results indicate that HIGT is clinically feasible. HIGT was achieved 90.9% of the time with TT vs. 66.6% of the time during OGT. HIGT was achieved a mean 36 minutes out of a total of 46 minutes per session. Achieving HIGT via OGT was more challenging due to increased fall risk. HIGT OG was accomplished with: running; resisted fast walking; ankle/trunk weighting; and stairs. TT achieved HIGT by: varying speed; increasing gradient; and limb weighting. Harness support would be recommended, as appropriate, to ensure safety and to maximize task demands with both OGT and TT. Future studies with larger sample sizes could provide evidence to identify the most effective training approaches for HIGT. To conclude, this case study provided examples of clinically feasible interventions to promote more consistent achievement of HIGT in the clinic.
Sabrina Degaspari
Centro Universitario Lusiada, Brazil
Title: Early mobilization of burned patient-A case report
Biography:
Sabrina Degaspari has completed her Master’s degree in Morphology at São Paulo University and PhD in Biosciences at São Paulo University. She teaches at Centro Universitário Lusiadas and at Santa Cecilia University and works as a Physiotherapist at Corpo e Água Clinic.
Abstract:
Treatment of burned patient represents a great challenge until today involving the active participation of many professionals constituting a true multidisciplinary body, whole ultimate goal is to save life, preserve functional activity and bring the patient back to social life. The burn is an injury whose cicatricial evolution is done anarchically and with great potential for sequelae, early-initiated physiotherapy treatment these sequelae prior its installation or formation of scar retractions. The purpose of this work is to present a case report of early mobilization of burn injury in hands, an extremity of body with a complex mobility. This study was conduct at burn unit of Santa Casa Hospital, in Santos, where we evaluated a patient who suffered a chemical burn in both hands, corresponding to a 5% of the burned surface according to international schema of Lund-Browdec and second and third burn degree depth were observed, without respiratory injury or other associated traumas. After evaluation of joint integrity and function as well as the burned surface, the physical therapy intervention was started with three interventions a day since first day of hospital internment, consisting of passive mobilization followed by active movement to stimulate the functionality. During the night it was oriented the use of positional ortheses. After three weeks, the granulation tissue was fit for skin grafting surgery and after this procedure the physiotherapy procedures remained one week interrupted. After two months the ambulatory follow-up was carried out, characterizing the final phase of rehabilitation process. We conclude that the precocious mobilization, even in a complex part of the body like hands, contributes to reduce scar complication and preserve the function allowing the quick return to daily activities with less complication and improving quality of life after lesion.
Marcus Orgel
Medical School Hannover, Germany
Title: Osseointegrated, percutaneously guided implants for rehabilitation after leg amputation-via the endo-exo-prostheses in hannover
Biography:
Marcus Orgel was a student of human medicine at the University of Heidelberg, Germany from 10/2007 - 10/2014, he was also a resident at the clinic for trauma surgery (Prof. Dr. med. Christian Krettek) during 06/2015 at Medical School Hannover, Germany and he is the deputy head of the section for endo-exo-prosthetic, clinic for trauma surgery (Prof. Dr. med. Christian Krettek) from 02/2017 at Medical School Hannover, Germany.
Abstract:
Introduction: The use of osseointegrated prostheses for limb amputation has been evolved over the last two decades as a promising alternative to the traditional external prosthesis. These systems are basically implants that are anchored intramedullary in the femoral or tibial section of the residual limb and extend outwards through the skin. This system is used by amputated since 1990 in few selected and special centers across the world (Sweden, Germany, Australia, Netherlands, and USA). The Section for Endo-Exo-Prosthetic moved 2017 from Lubeck to Hannover,Germany. Materials & Methods: Endo-Exo-Prostheses are carried out in a two-stage operation. In the first-step operation, the Endofix-Stem is implanted in the residual bone; this is followed by a healing phase of several weeks allowing for the osseointegration of the Endofix-Stem. The soft tissue component is placed in the second-step operation, where the components that pass through the skin are assembled to which the Exoprosthetics can be later attached. These patients suffered an amputation of traumatic etiology, by generalized sepsis with peripheral microcirculation disorders, arterial occlusions, or heparin-induced thrombocytopenia as well as an end of complication of multiple medical interventions, such as surgical treatment of fractures or elective orthopedic interventions with severe unexpected complications. A few patients had to undergo an amputation due to peripheral vascular disease and as part of the treatment of tumors. Results: Since February 2017 39 Patient have been treated by the Endo-Exo-Prostheses in Hannover. This includes the two-stage procedure, starting with the first-step operation followed by the second step after healing of the bone into the implant and continuing after healing respond with the physiotherapy guided rehabilitation work. Four operations had to be done due to infection of the soft tissue around the penetration part of this prostheses, one osteosynthesis had to be done due to a periprosthetic fracture. Our follow ups showed that all patients who have been treated by the Endo-Exo-Prostheses are able to walk with their prostheses and gain a good rehabilitation. Conclusion: The bone guided, transcutaneously diverted prosthetics (Endo-Exo-Prosthetic) for rehabilitation after limb amputation can be regarded as sufficiently safe according to the available data. It is therefore a valuable treatment option for patients who cannot be satisfactorily rehabilitated after upper and lower leg above or below knee amputation.
Khin Maung Bo
Rehab Medicine Service, Barnard Court Health Centre, UK
Title: Gait analyisis by video grabbed frame sketching, alternative to gait lab analysis
Biography:
Khin Maung Bo is involved in Neurorehabilitation for over 20 years. He is also a Lecturer in Hull and York Medical School teaching 4th Year Medical Students in CNS and Musculoskeletal Blocks. He is doing botulinum toxin injection in spasticity, dystonia and involuntary movement disorders over 15 years and done Poster presentations and Oral Presentations in International NeuroRehabilitation Conferences. He is also involved in using functional electrical stimulation over 10 years and presented regularly in International FES Conferences. He is working on developing Hypertonic Hand Monitoring Scale. He recently Published another Bedside Test In Neurology.
Abstract:
It is easy to use joint range of movement (ROM) as an outcome measure after intervention like botulinum toxin injection (BTI) in the treatment of spasticity. But, it is difficult sometimes to say if that ROM improvement leads to gait improvement. The objective is to sketch grab frames from video capture to assess gait improvement. This is a single case study. Forty-year-old gentleman who is suffering from multiple sclerosis received BTI in calf muscles of both legs in August 2016. Three weeks after the treatment, both ankle dorsiflexion had improved from -10° to neutral. The gentleman was saying there was no change in the way he walked. Sketches (Initial Contact phase & Initial Swing phase) were made from video grab frames before and after BTI. There was improvement in terms of symmetry of trunk (due to less hip hitching) and stride length (due to improve ankle ROM sketching grab frames from the video capture is an effective way of assessing gait improvement and is a good alternative to gait lab and is much cheaper and quicker.
Khin Maung Bo
Rehab Medicine Service, Barnard Court Health Centre, UK
Title: Functional neurology cases
Biography:
Khin Maung Bo is involved in Neurorehabilitation for over 20 years. He is also a Lecturer in Hull and York Medical School teaching 4th Year Medical Students in CNS and Musculoskeletal Blocks. He is doing botulinum toxin injection in spasticity, dystonia and involuntary movement disorders over 15 years and done Poster presentations and Oral Presentations in International NeuroRehabilitation Conferences. He is also involved in using functional electrical stimulation over 10 years and presented regularly in International FES Conferences. He is working on developing Hypertonic Hand Monitoring Scale. He recently Published another Bedside Test In Neurology.
Abstract:
Functional neurology disorder (FNDs) cases are not uncommon in neurorehabilitation practice. It is very challenging to rehabilitation professionals. Main presentations can be mobility problems, pain, weakness, speech disorder, coordination, psychological, seizure, dystonia etc. etc. Most of the time, they underwent extensive and repeated investigations leading nowhere. This is draining resources on health and social services. There will be three to four or more functional neurology cases with a variety of presentations. There are no smoking guns in diagnosing FNDs. The professionals need to pick up inconsistencies in the presentations with investigation findings.
Henri Henell
Physiotherapist Henri Henell, Norway
Title: Joint mobility-the key to longer and better life
Time : 14:00-14:15
Biography:
Henri Henell is a 49 years old Finnish physiotherapist who lives and works in Norway. He has education as a physiotherapist in Finland in 1996. In 2001 he has started his own private practice. Last ten years he has been using joint mobility drills with himself and part of the treatments. He has traveled around Norway to lecture about joint mobility. In 2015 came he out with print booklet in Norwegian about joint mobility which has sold over 750 examples. At the beginning of 2018 came joint mobility eBook in an English version in Amazon and Spring 2018 print in Finnish. Henri has also been part of the medical team at Sogndal Football where he used joint mobility in part of warm-up routines.
Abstract:
How would you feel to meet the daily challenges with full of energy, without stiffness and pain? Last ten years I have used joint mobility drills daily and educated these drills further. Many people have often difficulties to find an activity which is easy enough to do but at the same time effective. They have found joint mobility suitable activity. Our body is like car-engine it doesn’t work without oil we have about 100 joints in our body surrounded by joint capsules. It's well-known fact that circulation and nutrition to joints happen through movement how often we warm up our joints? Mostly we concentrate to warm up our muscles and don't give a thought our joints. When we move our joints, we smooth joint surfaces and lubricate them. This helps to get healthy joints and helps to maintain a full range of motion. Many people have been familiar with joint mobility drills during these ten years and feedback from people has been encouraging-people feel much better – stiffness and pain are gone or reduced, they feel more energetic and clearer to their heads. They can feel these results after a couple of weeks with joint mobility. And one of the best things with joint mobility drills is that its suitable for all people despite age, gender or form. You can do it everywhere at any time and you don't need any equipment since you carry your gym with you all the time. As a result of all feedback and work with joint mobility, I have made a little “cookbook” of joint mobility drills and I will keep on telling the benefits of joint mobility.
David IP
Wellness Pain Centre, Hong Kong SAR China
Title: Use of LLLT (Low Level Laser Therapy) in managing pain after fracture by healing the fracture
Biography:
Dr. Ip has registered qualifications in the field of Orthopaedics as well as Rehabilitation. He had previous post-graduate overseas training in Harvard University, Oxford University, Orton Rehabilitation Institute as well as Edinburgh Royal Infirmary. He is the author of many well-read textbooks in Orthopaedic Rehabilitation as well as on the use of low-level laser therapy. Dr Ip on average performs 5000 LLLT pain treatment on a yearly basis..
Abstract:
The talk will start off with a general introduction of the principles of low-level laser therapy, the mechanism whereby it has healing potential of injured body cells and the mechanisms of stimulation of bone formation using this advanced technology. This will be followed by its clinical applications in clinical practice using real life examples.
Gi-Young Park
Daegu Catholic University School of Medicine, South Korea
Title: Sonoelastography for skeletal muscle muslces
Biography:
Gi-Young Park graduated and got degree of MD, phd from Yonsei University College of Medicine (Seoul, Korea). He has been a head professor of Department of Rehabilitation Medicine in Daegu Catholic University Hospital since 2008. He ublished more than 100 papers in reputed journals and elected as the next president of Korean Academy of Neuromusculoskeletal Sonography. He have been teaching rehabilitation medicine and neuromusculoskeletal ultrasound since 1995 and has given many lectures and hands on instructions at courses organized by universities, academies, and societies in Korea, Taiwan, China, Japan, India, and Myanmar etc.
Abstract:
Real-time sonoelastography is a recently developed ultrasound-based imaging technique that evaluates tissue elasticity in real time. It is based on the principle that the compression of tissue produces a strain (displacement) that is lower in hard tissue and higher in soft tissue. Real-time sonoelastography provides information on tissue elasticity, in addition to the shape and vascularity, which are obtained via B-mode and Doppler ultrasound. Similar to B-mode ultrasound, manual or mechanical compression with the transducer and real-time visualization are now available for real-time sonoelastography in actual clinical practice. Tissue elasticity not only varies among different tissues but also seems to reflect disease-induced alternations in tissue properties. Real-time sonoelastography was recently applied to the normal and pathologic tissues in skeletal muscle disease, and it showed promising results and new potentialities. Therefore, it is expected to be a useful imaging modality for providing novel diagnostic information in skeletal muscle diseases because tissue elasticity is closely related to its pathology. It can also be used as a research tool to provide insight into the biomechanics and pathophysiology of skeletal muscle abnormality.
Gi-Young Park
Daegu Catholic University School of Medicine, South Korea
Title: Imaging diagnosis and intensive rehabilitation treatment of frozen shoulder
Biography:
Gi-Young Park graduated and got degree of MD, phd from Yonsei University College of Medicine (Seoul, Korea). He has been a head professor of Department of Rehabilitation Medicine in Daegu Catholic University Hospital since 2008. He ublished more than 100 papers in reputed journals and elected as the next president of Korean Academy of Neuromusculoskeletal Sonography. He have been teaching rehabilitation medicine and neuromusculoskeletal ultrasound since 1995 and has given many lectures and hands on instructions at courses organized by universities, academies, and societies in Korea, Taiwan, China, Japan, India, and Myanmar etc.
Abstract:
Frozen shoulder (FS) is an insidious, painful condition that results in a gradual restriction of movements. The primary pathologic change in IAC is inflammation, and the fibrosis reaction is a secondary reaction, leading to thickening, contracture, and adherence of the capsule and synovia as well as the surrounding ligamentous structures. Many patients continue to have a significant long term painful restriction in their range of motion, although few are functionally restricted. The normal course of FS has been described as having 4 stages: preadhesive, freezing, frozen, and thawing. The diagnosis of FS is based on a thorough history taking and physical examination. Radiographs of the shoulder are usually negative. Imaging studies including arthrography, ultrasonography, and magnetic resonance imaging can be used to rule out concomitant conditions that may affect the treatment and to confirm FS. The goals of treatment are to relieve pain, to restore restore func¬tion and motion of the shoulder, and improve quality of life. Treatments for FS range from con¬servative treatments including physical therapy, therapeutic exercise, joint mobilization and manipulation, nonsteroidal anti-inflammatory and opioid medications, intra-articular steroid and hyaluronic acid injections, suprascapular nerve block, glenohumeral distention ar¬thrography with and without steroid supplementation, and manipulation under general anesthesia to surgical intervention. Clinically effective joint mobilization and manipulation improves tissue extensibility, reduces soft tissue swelling and inflammation, reduces pain, increases range of mo¬tion, and stimulates peripheral mechanorecep¬tors in FS. It is necessary to refine the selection of treatment for individual patients according to the phase of the disease.
Samah Alharbi
King Faisal Specialist Hospital and Research Centre, Saudi Arabia
Title: Case study: Physical therapy protocol for the management of obstetric brachial plexus palsy
Biography:
Samah has completed her master degree from Brighton University, UK. She is a senior therapist in the physical therapy department at King Faisal Specialist Hospital Riyadh SA. She worked with brachial plexus injuries post surgery since 2012, and specialse in pediatric area.
Abstract:
Background: There are 125 patients undergoing brachial plexus surgery upper region at King Faisal Specialist Hospital and Research Center from 2005-2015. 80% of them need extensive physical therapy post-surgery, which is proven to enhance the full recovery of the arm function, according to the evidence based studies. Study design: The case study was used to high light the role of physical therapy in the treatment of brachial plexus palsy post-surgery. Case description: 13 months old Saudi girl had been diagnosed with left C5-C6 brachial plexus injury (Narakas 1) patient underwent exploration and bilateral nerve grafting on the age of three months old, placed in baby holder for three weeks. Then the orthopedic physician referred her to the physical therapy clinic for OBPP protocol. Management & Outcomes: The patient received one session per month included: positioning and instructions to handle the patient in proper way, passive range of motion, active range of motion and strengthening exercises. Sensory stimulation and certain programs facilitate normal posture and motor development. At the second visit the patient started to improve gradually in ROM and MP. After six months of treatment, the patient able to pull herself to stand alone, cruising independent and get crawling position with left hand opened and in proper position on the floor, the ROM & MP almost within normal limit. Discussion: This case study showed that the early physical therapy intervention post-surgery for brachial plexus injury upper region can improve/cure the patient condition.
Najwa Alfarra
King Faisal Specialist Hospital and Research Centre, Saudi Arabia
Title: Impact of action II petite lady laser machine in the treatment of urinary incontinence and sexual dysfunction female
Biography:
Najwa Alfarra is from King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
Abstract:
Introduction: Urinary incontinence & sexual Dysfunction is very common among female. It causes social or hygienic problem. Urinary incontinence is the uncontrolled leakage of urine. This condition affects about a third of the female population and is more common in women than in men (Gaspar, Addamo & Brandi, 2011). The Petite Lady treatment is a non-invasive way that is aimed at awakening a woman’s sensuality by tightening up their vaginal canal. Moreover, the method reduces urinary incontinence problem. A lot of people view it as an alternative to the traditional surgical methods that are seen to have side effects. Since there are variations in the impact of the treatment methods, the area needs a lot of research. Objective: The objective of the study was to evaluate the impact of the Action II lady laser machine in the treatment of sexual dysfunction and urinary incontinence in females. Methods: Will assist 30 women, aged 25-55 years old with sexual dysfunction in stress incontinence confirmed by patient history and urodynamic study. We will evaluate the impact of Action 11 Petite Lady Laser Machine in the treatment of urinary incontinence and female sexual dysfunction confirmed by using the Female Sexual Function Index (FSFI) Arabic validate version by (Anis , et al. 2011), measuring vaginal muscle power by using PFX2, and bladder diary. These questions were answered by the patient before we commenced the treatment and after 10 weeks of completing the treatment. The muscle power were measured before and after the treatment, it was conducting at the physical therapy department. Furthermore, the survey included a participant information sheet outlining the nature of the study. The study took a place at King Faisal Specialist Hospital and research center. Main Outcome Measures: In the voiding diary the women reported that the urinary frequency, episodes of urgency and urine leakage during sneezing, coughing, and laughing dramatically improved by 85%. The domain scores of the FSFI, including desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated and showed huge improvement in mean score increased by more than 3 points at all subjects after completed the treatment by 90%. The muscle power of the pelvic floor improved in all cases the mean of muscle power before the treatment was 2/5 after the treatment became 3+-4/5. The treatment protocol was 4 sessions at 2 weekly intervals for the first three sessions, then one month interval between the third and fourth session, with 2940nm Er: YAG via 90 degree scanning scope. Results: All the subjects successfully completed the study with no adverse events. Significant improvement in vaginal wall relaxation was seen in all subjects at 2 months and half post treatment based on the PFX2values, on the partners input for vaginal tightening 83%, for sexual satisfaction as assessed by the subjects themselves (90%) and bladder diary showed decrease in leakage during coughing, sneezing and laughing by 85% see figure 1. The preliminary results confirm that laser treatment is an effective, safe and comfortable treatment option for symptoms relief in patients with SUI and sexual dysfunction.
Fatimah Ahmad Alzaher
King Fahad Military Medical Complex, Saudi Arabia
Title: The effect of physiotherapy program on hip pain and postural control in adolescents with sickle cell disease
Biography:
Fatimah Alzaher has completed her bscpt from King Saud University in 2007 and scpt from Imam Abdulrahman Bin Faisal university in 2018 from Saudi Arabia. She is working as a senior PT in King Fahad Military Medical Complex in Dhahran since 2007 till now. Successfully treating patients and training fresh graduates in different fields of physiotherapy such as orthopedic, neuro, pediatric and other physiotherapy subspecialties.
Abstract:
Background: Sickle cell disease (SCD) is one of the most known genetic diseases in Saudi Arabia. With a common complication found to be the avascular necrosis (AVN) of the femoral head by 27% in eastern province. This AVN causes distraction of the hip joint, pain, and other complications. Objectives: the aim of this study was to measure the effect of physiotherapy program on pain intensity and postural stability in sickle cell disease adolescents with hip avascular necrosis. Methods: 21 participants who are aged between 10 to 18 years old and known to have SCD with hip AVN were recruited. Measurements were taken at baseline and at the end of the treatment program. Wong-Baker FACES pain rating scale was use to evaluate the pain intensity. Biodex Balance System was used to evaluate the OSI. Manual goniometer was use to evaluate the ROM. Manual muscle testing was used to evaluate the MP. The statistical outcome differences within the group analysis was measured using paired t-test. Wilcoxon signed rank test was used to measure the differences within the group analysis for non-parametric variables. Results: All participants showed improvement in pain intensity, OSI at level 6, ROM, and MP. However, OSI at level 12 post-test result was better than the pre-test result, but it did not give a significant statistical difference. Conclusion: Physiotherapy program proved to be effective method to improve the pain intensity and postural stability in SCD patients with hip AVN. Furthermore, improvement of ROM and MP will improve or limit the related complications.
Ertan Tufekcioglu
King Fahd University of Petroleum and Minerals, Saudi Arabia
Title: A novel method watsu can be incorporated into hydrotherapy programs for increasing range of motion
Biography:
Ertan Tufekcioglu has completed his PhD in the Institue of Health Sciences at Marmara University. He was the Director of the sports and cultural complexes in Istanbul, before he has started his academic studies in rehabilitation and recovery methods at KFUPM. He has published many papers in reputed journals and has been serving as a Scientific and Curriculum Committee Member and Editorial Board Member of an international journal.
Abstract:
Background: Although, aquatic therapies have been shown to be beneficial for a variety of physical and psychological disorders, there is a lack of research on emerging Watsu® Therapy in clinical settings. In our study, effect of Watsu® on ROM and MAS scores of children with Cerebral Palsy were investigated. Methods & Results: Twenty-three children with CP whose family signed the consent forms were included in the controlled study. Subjects with average age of 7.5 years -+2.8 and BMI of 17 +-3.7 were assigned randomly to either Watsu therapy (W) and Control groups according to an aged-stratified randomization. They receieved Watsu therapy two times per week for 10 weeks. Spasticity (MAS) and flexibility (ROM) scores were investigated with Paired t test. Watsu® increased lower flexibility significantly (P<0.05). Positive change seen in MAS scores were not significant. Conclusion: In the experimental condition, Watsu® therapy increased the lower flexibility of children with CP. We recommend Watsu® therapy to be incorporated in to aquatic treatment settings to enhance lower flexibility of children with CP. However, more emphasize may be placed on the upper body Watsu techniques for future studies.
Ann Tamm
Tartu University Hospital, Estonia
Title: Early diagnosis of knee osteoarthritis to enable non-pharmacological treatment
Biography:
Ann Tamm is from Tartu University Hospital, Estonia.
Abstract:
Introduction: Osteoarthritis (OA) is a leading cause of morbidity and disability carries high socioeconomic costs. With increasing obesity and age in the population, a massive rise in morbidity and costs attributed to OA is expected. New concepts of early diagnosis and treatment of early OA conditions may improve outcomes and reduce disability and costs for OA, the most prevalent form of arthritis. Methods: The baseline data for 560 participants of the Estonian early knee OA cohort, 70 arthroscopic patients and 50 arthroplasty patients were used. Patients underwent a physical examinations (4 tests recommended by OARSI), self registrated KOOS questionnaire and radiographic examination patellofemoral (PF) and tibiofemoral (TF) joints of both legs. Also some biomarkers (COMP. hs-CRP, u-C2C, IP10; TIMP2:TIMP4) were used. Follow-up data over a period of 9 years of cohort study and 1-3 years after arthroscopy and arthroplasty were used. Results: During the 9 year follow-up period of early OA non-linear course of the disease was demonstrated. The functional ability of lower limb expressed by 4 functional tests and KOOS decreased slowly. Clear gender differences were demonstrated in disease progression. Using biomarkers (IP10; TIMP2, TIMP4) in OA radiographic Grandes 0-I promise more early detect the disease progression speed. The u-C2C values were significantly higher for patients with tibial or femoral lesion degree 2 or higher both at baseline and 3 yrs. after arthroscopy. Excretion of u-C2C correlated positively with knee symptoms as well as with limitations of everyday and demanding recreative (Sp/Rec) activities (p<0.0000). Higher output of u-C2C correlates with decline of the functional abilities of lower limb. Conclusions: Self registrated KOOS questionnaire and measured functional ability of lower limb demonstrated good practical value in different knee OA Grades, in different patient groups and in different time points The main radiological features of KOA could be described by a restricted number of key BMs involved in tissue remodeling by TIMP/MMP and the TGF system. Significantly higher excretion of uC2C is associated with grade 2 cartilage lesion in knee joint. Highly significant correlation appears between increased uC2C outputs and decline in the clinical parameters of the lower limb
- Physiotherapy
Chair
Ivet B Koleva
Medical University of Sofia, Bulgaria
Co-Chair
Shiv Singh Sarangdevot
Janardhan Rai Nagar Rajasthan Vidyapeeth, India
Biography:
Ghaidaa Hamid Aljehani has completed her Master’s degree in Advancing Physiotherapy Practice at Coventry University, UK. She is a Certified Lymphedema Therapist from Klose Training Institute at Colorado, USA. She has more than five years of experience in lymphedema and oncology rehabilitation in Saudi Arabia.
Abstract:
Aim: The purpose of this review was to investigate the effectiveness of supervised exercise program in comparison to the unsupervised exercise program in improving quality of life, maintaining functional activity and limiting fatigue in survivors of colorectal cancer by appraising the current evidence.Method: To meet the research question (i.e. What is the effectiveness of a supervised exercise program in comparison to the unsupervised exercise program in improving quality of life maintaining functional activity and limiting fatigue in survivors of colorectal cancer?), various electronic databases (i.e. AMED, MEDLINE, CINAHL, pedro, Academic Search Complete, sportdiscus, psycinfo) were systematically searched for relevant randomised controlled trials that met the inclusion and exclusion criteria. Primary outcomes of all relevant studies were assessed using CASP an Cochrane risk of bias tools. The primary outcome-the quality of life was measured in all eight studies selected for this review. Results: Eight rcts studies involving 996 participants with colorectal cancer were included in this review. The stage of cancer varied (stages I-III, Duke's stage A-C), and the period since therapy varied also across rcts from immediately after the surgery to up to five years. The majority of participants were male with an age range between 55 to 69 years old in both groups. All the selected studies have obtained ethical approval from their respective institutional boards the overall quality of included studies was high to good, indicating a reliable methodological quality and reveals a low risk of bias. Overall there was a significant improvement in the quality of life, functional activity and fatigue in both groups. Moreover, quality of life, functional activity and physical fitness seem to have a positive impact at a short time frame in the supervised group in comparing to the unsupervised group. However, at a longer time frame, the quality of life showed no significant difference between groups. According to fatigue level, after six months there was a significant improvement in fatigue level in the supervised group in comparing to the unsupervised group. Higher doses of exercise improved many parameters in hrqol compared to lower doses. Conclusion: This systematic review overall shows short-term benefits with low to medium intensity aerobics exercises in terms of physical fitness. There was no significant difference in the quality of life at a longer time frame between the supervised and unsupervised group. However, fatigue level showed a considerable improvement in a longer period in the supervised group compared to an unsupervised group.
Ivet B Koleva
Medical University of Sofia, Bulgaria
Title: Impact of functional electrostimulations in the complex neurehabilitation algorithm of patients with multiple sclerosis Ivet B Koleva, Medical University
Biography:
Prof. Ivet Borissova Koleva is a medical doctor, specialist in Neurology and in Physical & Rehabilitation Medicine; with 30 years of clinical practice in the domain of NeuroRehabilitation. Actually, she works as a professor at the Medical University of Sofia, Bulgaria.
Abstract:
Introduction: Multiple sclerosis (MS) is a socially important disease, with a high level of acquired disability in a relatively young population. Motor weakness, spasticity, balance and coordination dysfunctions provoke severe difficulty in everyday activities of MS patients. Aim: Our aim was to evaluate the impact of functional electrostimulations (FES) in the complex neurorehabilitation (NR) algorithm of MS patients (cerebro-spinal form, relapsing-remitting evolution). Materials & Methods: We observed a total of 164 patients with clinically and MRI proved MS, with spastic paraparesis and cerebellar ataxia (static, locomotory and dynamic dyscoordination); 2-4 weeks after a relapse. Patients wererandomized into two therapeutic groups (82 per group). The control was done before, during and at the end of the NR course (of 20 treatment days), and one month after its end - using a battery of clinical methods and functional scales. In all patients we applied a complex NR programme of cryophysiotherapy and ergotherapy; including proprioceptive neuromuscular facilitation techniques; balance, coordination and gait training; goal-oriented activities. Group (gr) 1 received only this NR programme. In gr 2 we added FES for the extensors of the ankles and feet. Results: The comparative analysis of results demonstrates significant amelioration, most important in the FES group: diminution of spasticity; reduction of the motor weakness; amelioration of the gait stability and balance (Berg Balance scale); improvement of functional capacity (EDSS scale of Kurtzke), and autonomy (FIM–Transfers and Locomotion subscales; Barthel index - subscales Mobility and Stairs). Conclusion: Functional electrostimulations are important part of the neurorehabilitation algorithm in MS patients.
Todor Krasimirov Dimitrov
Medical University of Sofia, Bulgaria
Title: Evaluation of the impact of cognitive disorders on the quality of life of patients with multiple sclerosis
Biography:
Todor Krasimirov Dimitrov has completed his PhD in the Faculty of Public Health at Medical University-Sofia, Bulgaria; Bachelor’s degree in Rehabilitation, second Bachelor’s degree in Health care and Master’s degree in Public health and Health Management. He is working as a Chief Assistant Professor in the Physiotherapy Department at the Faculty of Public Health.
Abstract:
Leading to major cognitive and motor disorders multiple sclerosis (MS) is a socially significant disease. It affects young people in creative working age. The disability of these patients requires careful choice of treatment approaches, in order to improve their quality of life which is severely impaired. Quality of life is an extremely important indicator of medicine and healthcare management. The influence of a specific therapy and a complex healing program improves a number of lifestyle-related symptoms. Systematic observation and evaluation of patients with this decease allows us to seek opportunities for a change- improving the social status of patients, allowing them to work and to maintain daily activities. Attention is usually paid only to motor activity and capacity. Cognitive impairment leads to improved social adaptation; it reflects the emotional sphere, characterized by mood swings and the development of depressive states. The long-term course of the disease, emersion of new symptoms and the deterioration of old ones, have a very serious impact on the patient’s quality of life. The significant degree of disability of MS patients in their early and active age is a great challenge for further seek and research of the causes for this disease and the development of new healing methods. The special focus on neuro-rehabilitation, both on physical and cognitive disorders, is a prerequisite for improving the correspondent functions according to the extent of their disorder. Dynamic assessment of quality of life through the use of specific methodologies could lead to the creation of active approaches for optimal treatment, recovery and support which will ensure the possible well-being of multiple sclerosis patients. These necessitates need to study and analyze the impact of rehabilitation on quality of life of patients with this disease.
Julieta Simeonova Gerenova
Medical University of Sofia, Bulgaria
Title: Anterior shoulder joint instability-phases of physiotherapy treatment
Biography:
Julieta Simeonova Gerenova has completed her Graduation in physiotherapy in 2008 and PhD in 2015. She is teaching in the Faculty of Public Health at Medical University-Sofia from 2013. She has published more than 10 articles in refereed journals.
Abstract:
Anterior shoulder instability is condition which has very high percent among young sportsmen, especially over-head athletes and contact sports. The great mobility of the shoulder joint enables the arm to occupy different positions in space. The price of this mobility is the relative instability of the joint. Due to its anatomy and biomechanics, shoulder is most often becomes instability joint -about 50% of all dislocations. The most frequent and recurrent is the anterior luxation, which affects the function of the joint-pain and instability. Our survey shows that when patients started physical therapy during the immobilization period the pain decreases and the amount of motion in the shoulder joint is increasing faster than patients started exercise after immobilization period. Study included 38 people with anterior luxation of shoulder joint which are divided into two groups-group A-20 people and the control group-18. The study was conducted within 14 months.
Biography:
Borislav Radoslavov Yoshinov is physiotherapist, graduated from the Medical University of Sofia. He works at the rehabilitation hospital ‘Yasen – Bankya’ – Sofia. He is studying Medicine (Medical Faculty of Sofia University, Bulgaria).
Abstract:
Introduction: Diabetic polyneuropathy (DPNP) is a socially important disease with a serious complication-diabetic foot (DF). Aim: The aim of our study was to evaluate the impact of LASER and Deep Oscillation in the complex neurorehabilitation (NR) algorithm of DPNP and neuropathic DF. Material & Methods: We observed a total of 375 patients with clinically and electromyographically (EMG) proved DPNP (sensorimotor form, distal symmetric type) and neuropathic DF (Charcot type). Patients were randomized into three therapeutic groups (75 per group). The control was done before, during and at the end of the NR course (of 20 treatment days), and one month after its end. In all patients we applied a complex NR programme of physiotherapy and ergotherapy (analytic exercises, soft tissue techniques; low intensity physical activities); peloidotherapy (sea lye compresses); patient education. Group (gr) 1 received only this NR programme. In next groups a preformed modality was added: LASER in gr 2; Deep Oscillation - in gr 3. For database management we used t-test (ANOVA) and Wilcoxon signed rank test. Results: The comparative analysis of the results demonstrates statistically significant beneficial effects on: irritative sensory signs (VAS), hypoesthesia; hypopallesthesia (vibroesthesiometry); trophic feet alterations (Shenaq scale); electroexcitability and electroconductibility of peripheral nerves (EMG). The results in gr 2 (Laser) were significantly better concerning VAS and Shenaq rate; and in gr 3 (DO)-on vibration sense and pain. Conclusion: LASER therapy and Deep Oscillation must be part of the NR-algorithm in DPPNP-DF-patients. Laser improves pain and trophic foot alterations. DO influences sensibility (tactile and vibration).
Biography:
Borislav Radoslavov Yoshinov is physiotherapist, graduated from the Medical University of Sofia. He works at the rehabilitation hospital ‘Yasen – Bankya’ – Sofia. He is studying Medicine (Medical Faculty of Sofia University, Bulgaria).
Abstract:
Introduction: Diabetic polyneuropathy (DPNP) is a socially important disease with a serious complication-diabetic foot (DF). Aim: The aim of our study was to evaluate the impact of LASER and Deep Oscillation in the complex neurorehabilitation (NR) algorithm of DPNP and neuropathic DF. Material & Methods: We observed a total of 375 patients with clinically and electromyographically (EMG) proved DPNP (sensorimotor form, distal symmetric type) and neuropathic DF (Charcot type). Patients were randomized into three therapeutic groups (75 per group). The control was done before, during and at the end of the NR course (of 20 treatment days), and one month after its end. In all patients we applied a complex NR programme of physiotherapy and ergotherapy (analytic exercises, soft tissue techniques; low intensity physical activities); peloidotherapy (sea lye compresses); patient education. Group (gr) 1 received only this NR programme. In next groups a preformed modality was added: LASER in gr 2; Deep Oscillation - in gr 3. For database management we used t-test (ANOVA) and Wilcoxon signed rank test. Results: The comparative analysis of the results demonstrates statistically significant beneficial effects on: irritative sensory signs (VAS), hypoesthesia; hypopallesthesia (vibroesthesiometry); trophic feet alterations (Shenaq scale); electroexcitability and electroconductibility of peripheral nerves (EMG). The results in gr 2 (Laser) were significantly better concerning VAS and Shenaq rate; and in gr 3 (DO)-on vibration sense and pain. Conclusion: LASER therapy and Deep Oscillation must be part of the NR-algorithm in DPPNP-DF-patients. Laser improves pain and trophic foot alterations. DO influences sensibility (tactile and vibration).
Borislav R Yoshinov
Sofia University, Bulgaria
Title: Clinical approval of our own neurorehabilitation programme for parkinsonic patients
Biography:
Borislav Radoslavov Yoshinov is physiotherapist, graduated from the Medical University of Sofia. He works at the rehabilitation hospital ‘Yasen – Bankya’ – Sofia. He is studying Medicine (Medical Faculty of Sofia University, Bulgaria).
Abstract:
Introduction: Parkinsonism (Prk) is a neurodegenerative disorder, considered as a socially important disease with serious impact on autonomy and quality of life of patients. Primary clinical patterns include: static tremor, muscle rigidity (muscular and articular stiffness), brady-hypo-kinesia (including hypomimia), typical Prk-posture and Prk-gait, pulsion phenomena (antepulsio, retropulsio, lateropulsio). There is a lot of secondary autonomic and psychic signs and symptoms, especially anxiety or depression. In advanced Prk-cases some movement problems are observed, e.g. freezing and on-off phenomena; peek-of-dose-dyskinesias; etc. During last years we elaborated a complex neurorehabilitation (NR) programme, adapted to dysfunctions and problems in everyday life of Prkpatients,including physiotherapy, ergotherapy & patients’ education: analytic exercises for paravertebral muscles & for extremities; soft tissue techniques for rigid muscles; balance, transfer & coordination training; grasp & gait training; speech & mimic exercises; training in activities of daily living. Aim: The aim of current study was to realize a clinical approval of this complex NR-programme in parkinsonics. Material & Methods: We observed a total of 186 Prk-patients; randomized into two therapeutic groups (gr). In gr-1 we applied traditional physiotherapy; and in gr-2 - our complex NR-programme. For database management we used t-test (ANOVA) and Wilcoxon signed rank test. Results: The comparative analysis of the results demonstrate statistically significant amelioration (most relevant in gr-2) concerning: rigidity; mobility; pain; depression; autonomy and quality of life of Prk-patients; visualized by Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr scale; 6-Minutes Walk test, Timed Up and Go test, Balance scale and stabilometry. Conclusion: We recommend our own NR programme.
Ivet B Koleva
Medical University of Sofia, Bulgaria
Title: Complex rehabilitation programmes for diabetic neuropathy patients
Biography:
Ivet Borissova Koleva is a Medical Doctor, Specialist in Neurology and in Physical & Rehabilitation Medicine with 30 years of clinical practice. She has completed her PhD thesis on ‘Physical Prevention and Therapy of Diabetic Polyneuropathy’ and a thesis for Doctor-es-Medical Sciences on ‘Neurorehabilitation in patients with socially important neurological diseases’. She received the titles of Associate professor in 2006 and Professor in PRM at 2010. She works at the Medical University of Sofia, Bulgaria. She is the Author of scientific papers, monographs and manuals in the fields of Rehabilitation, Manual Medicine, Grasp and Gait rehabilitation, Functional evaluation and Pain management.
Abstract:
The modern diabetology explains clinical patterns of the continuum: metabolic syndrome–>non-insulinodependentdiabetes mellitus–>diabetic neuropathy (DN). Etiopathogenetic mechanisms include metabolicand vascular factors, converging to oxidative stress and development of segmentary demyelinization or/and axonal(Waller) degeneration of the peripheral nerves of diabetic patients. The diabetic neuropathy (somatic or autonomic) is a “silent” pathology provoquing severe complications. The purpose of our study is to create an algorithm for functional assessment and physical therapy of different DN-types and to evaluate qualitatively and quantitatively the efficacy on signs and symptoms of DN-patients. We evaluate a total of 1023 DN-patients (sensorimotor form, proximal or distal type). The complex physical-therapeutic and rehabilitation (PhThR) programmes include: physiotherapy (analytic exercises, soft tissue techniques-massage, PIR, stretching, tractions, mobilizations); peloidotherapy (fango/mud/ or sea lye compresses); patient education; pre-formed physical modalities (iontophoresis, TENS, FES, magnetic field, LASER therapy, Deep Oscillation). For database management we used t-test (analysis of variances ANOVA) and Wilcoxon signed rank test (non-parametric distribution analysis). The comparative analysis of the results before and after therapy demonstrates statistically significant beneficial effects on many clinical patterns (part of them remain stabilized one month after the treatment): decrease of irritative sensory signs (VAS), tendency to normalization of hypopallesthesia (vibroesthesiometer of Riedel-Seifert); reduction of the muscle weakness (manual muscular testing); tendency to normalization of quantitatively and qualitatively altered electro-excitability of peripheral nerves in response to stimulation with galvanic or neofaradic currents (excitomotory electrodiagnostics). The complex rehabilitation programme must be individualized in every concrete case.
Inna Mincheva Ivanova
Medical University of Sofia, Bulgaria
Title: Impact of physical activity on berg balance test scores in female patientswith multiple scleros
Biography:
Inna Ivanova graduated her PhD in 2016 from National Sports Academy “Vasil Levski”. Since November 2016 she is an assistant professor at the Medical University of Sofia while simultaneously teaching at the Sofia University, until nowadays. She has several publications in journals in her home country and several abroad.
Abstract:
Multiple Sclerosis (MS) is a relapsing or progressive neurological disease with an unknown etiology. MS has a negative impact on both physical and psychological well being. One of the most common symptoms, reported by patients is the disturbance of balance. The purpose of the study was to test how a new combination of physiotherapeutic methods will affect the balance in females with multiple sclerosis. Methods: The study took place in Sofia, Bulgaria with 22 participants – women, clinically diagnosed with relapsingremitting multiple sclerosis, duration over 5 years and more than 4 crises. We used the BBS – The Berg balance scale to measure the changes in their ability to obtain balance in our patients. The whole program included 16 classes of hippotherapy and 20 classes of physiotherapy. The physiotherapy included exercises with big swiss-ball (fit-ball), modified exercise from PNF (proprioceptive neuromuscular facilitation), myofascial massage and autogenic training. Each woman started with 10 weeks of physiotherapy, after which continued with the 16 sessions hippotherapy. Results: At the end of the study our female patients showed statistically significant increase of the results in the BBS. Each one of them started to feel much more confident in the performance of the test’s components. We think that it is due to the effect of the selected exercises and methods both strengthening and relaxing at the same time. Each one of the exercises required the possibility of minor motor control of the body so that by repetition to strengthen muscularity properly Conclusion: Long term programs help the female patients with MS to achieve progress and keep the positive results for a long period of time. And hopefully to make them permanent.
Samaneh Ebrahimi
Shiraz University of Medical Sciences, Iran
Title: Pelvis-trunk sagittal, frontal and transverse inter-segmental coordination and variability in chronic nonspecific low back pain subjects during walking
Biography:
Samaneh Ebrahimi has completed his PhD at the age of 31 years from Shiraz University of Medical Sciences, Shiraz, Iran. She is an assistant professor in the Shiraz School of Rehabilitation Sciences. She has published different papers in different journals and has been serving as as a reviewer for some journals. Moreover she has been serving as an editorial board member of Journal of Rehabilitation Sciences & Research (JRSR).
Abstract:
Introduction: Inter-segmental coordination and coordination variability, which is an important factor in motor control system assessments during walking, can be affected by different disorders. Nonspecific chronic low back pain (CLBP) is one of the most prevalent musculoskeletal disorders which has been attempted for many years to find its motor control abnormalities in order to be able to prescribe more efficient treatment protocols. The aim of this study was the comparison of the pelvis-trunk coordination and variability, in all motion planes, in the subjects with and without nonspecific CLBP during walking. Methods: 15 healthy and 15 CLBP volunteers participates in this cross-sectional study. The kinematic data were collected while the subjects were walking at their preferred speed in a 10m walkway. Pelvis and trunk angles were calculated through V3D® software. The Inter-segmental coordination and coordination variability were calculated through continuous relative phase method during stance and swing phases of gait. Results: The trunk-pelvis coordination in the sagittal & frontal plane were statistically more in-phase and less variable during stance and swing phases in CLBP patients. However, the transverse plane revealed no significant difference. Conclusion: The analysis showed that pelvis-trunk coordination and variability could be affected in the sagittal and frontal planes by CLBP during walking. These results may enhance the body of literature which attempts to quantify the CLBP associated problems in walking. Moreover, the results suggest that the dynamical systems approach based evaluations might be considered valuable to improve the clinical assessment of gait patterns and the effectiveness of rehabilitation programs for CLBP patients.
Swati
Dr. D Y Patil College of Physiotherapy, India
Title: Effect of kinesio taping as an adjunct to oral motor therapy on drooling in children with neurological impairement
Biography:
Swati has completed her Bachelors of Physiotherpay at Guru Nanak Dev University, Amritsar, Punjab, India in 2017. Currently, she is pursuing her Postgraduation degree in the field of Pediatric Physiotherapy at Dr. D Y Patil College of Physiotherapy, Pimpri, Pune, Maharasthra, India.
Abstract:
Introduction: Drooling is considered as the unwanted dribbling of saliva from the mouth, which is considered common in children upto 15-18 months of age and considered abnormal if it continues after that with different severity and frequency and mostly encountered in children with neurological imapirement. Along with the articulation dysfunction, drooling impacts socialization, interpersonal relationships and integration into society for these patients. Regardless, of the aetiology and severity of drooling, it is estimated that 10-37.5% of children with cerebral palsy have drooling problem significant enough to interfere with the daily life. And most of the patients with drooling are considered to have problems affecting the head and neck positioning, typically adopting a head down positon, open mouthed attitude, everted lower lip all leading to drooling. Objective: To validate the effectiveness of kinesiotaping for management of drooling by enhancing the lip closure; To find out the time efficient protocol between kinesio tape and oral motor therapy in reducing the severity and frequency of drooling and reduce the social stigma caused by drooling among children with neurological imapirement. Method: The study is an experimental study design dividing the sample population of 30 children into two groupe. with convenient sampling (random allocation). Group A includes interventional technique receiving oral motor therapy, whereas Group B receives both the interventions including oral motor therapy and kinesiotaping as their intervention. The drooling score is compared at the end of every week for four weeks with frequency and severity of drooling by Thomas-Stonell Drooling Scale, Drooling Impact Scale and the lip closure measurement, measured by vernier caliper (accuracy of calliper 0.05mm). Results: As the study is being carried out and will be completed upto December 2018, the results are yet to be commented on.
- Poster presentation
Location: Olimpica 1
Session Introduction
Asma Abdullatife Alderaa
King Saud University, Saudi Arabia
Title: Chronic lower limb oedema in a population of saudi arabian residents with multiple sclerosis: An evaluation of progressive resistance exercise
Biography:
Asma Alderaa is a phd student in the University of Nottingham, UK, at her last year. She earn her Master degree from St Gorges univeirty in London in 2011. She is a Lecturer at King Saude University, KSA. Her main research interest is in multiple sclesrosis and lymphatic system.
Abstract:
Introduction: The prevalence rate of Chronic Lower Limb Oedema (CLLO) in people with MS (pwms) has been reported to be between 45% and 62% respectively (Solaro et al., 2006; Keeley et al. 2017). Statistical significance was found between age and Expanded Disability Status Scale (EDSS), where older patients with more disability were more likely to have oedema (ibid). Evidence of of chronic oedema managements are mainly a specific group related management or in A form of components treatment where the effectiveness of one component rather than the other can Not be confirmed. Moreover, evidence related to non-pharmacological intervention in forms of Exercises to treat CLLO with MS people has not been investigated thoroughly. Therefore, with this Lack of evidence in this area this study is aimed to assess the effectiveness of progressive resistance Exercise (PRE) in the management of changing chronic lower limb oedema (CLLO) in people with MS who are resident in Saudi Arabia and to determine the impact of CLLO on MS patients’ quality Of life. Methods: Two-hundred and fifty-five pwms and EDSS between 3 to 6.5 were screened from two Hospitals for CLLO by using a pitting oedema test. Twenty-two were found to have CLLO, However, fifteen out of them agreed to participate in the study. The participants performed a Biweekly 12-weeks lower limb PRE. The participants were assessed for any changes in their lower Limb circumference pre and post intervention using a 4 cm interval circumference which divided the Legs into 6 segments. In addition, Quality of Life (QOL) was measured by using the Quality of Life Measure for Limb Lymphedema (LYMQOL) tool and Short form of the mcgill Pain Questionnaire (SF-MPQ) in pre and post intervention. Results: Fourteen participants completed the intervention with mean age of 44±7.11 years, EDSS 5.6±0.96, BMI 29.08±7.91 and disease onset 12.92±3.7 years. A part from the 5th segment in the Right leg, mean difference volume reduction was reported in all segments and a greatest reduction Can be seen in the 1st segment -9.11 ml (SD 27.5) followed by 6th segment -8.57 ml (SD 20.3).However, none of the segments were statistically significant. In the left leg, again the highest mean Difference volume reduction can be seen in the 2nd segment -5.37 ml (SD 15.5) then 1st -4.51 ml (SD 12.2) and followed by 6th -1.74 ml (SD 30.4). Similar to the right leg, none of the left leg Segments were statistically significant. In terms of pain and QOL, statistically significant reduction Was reported in the Visual Analog Scale (VAS) domain P=0.01 and present pain intensity (PPI) Domain P=0.02, and statistically significant increase in the overall QOL domain P=0.006. Conclusion: This twelve-week program results demonstrate that PRE has effects on CLLO in terms Of pain and QOL in pwms. However, no statistically significant was found in the legs volume but Mean difference reduction was reported at different segments in both legs. More research with Bigger sample size is necessary.
Marcus Orgel
Medical School Hannover, Germany
Title: Transcutaneous Osseointegrated Prosthetic Systems (TOPS)-pain after mobilization: What kind of role does the angle of abduction play?
Biography:
Marcus Orgel was a student of human medicine at the University of Heidelberg, Germany from 10/2007 - 10/2014, he was also a resident at the clinic for trauma surgery (Prof. Dr. med. Christian Krettek) during 06/2015 at Medical School Hannover, Germany and he is the deputy head of the section for endo-exo-prosthetic, clinic for trauma surgery (Prof. Dr. med. Christian Krettek) from 02/2017 at Medical School Hannover, Germany.
Abstract:
Transcutaneous osseointegrated prosthetic systems (TOPS) have been used as an alternative method to the external artificial limbs for patients with limb amputation. Patients with transfemoral amputations very often suffer from pain in the region of their lateral hip following rehabilitation with TOPS after starting full weight bearing. We suppose a dependency between this pain and the malposition of the residual femur bone which tends to abduction. When socket prosthesis is used, weight bearing doesn’t have a direct effect on the bone. The energy is spread to the soft tissue. Due to the inevitable missing at least of parts of the mm. adductoris, there often exists a lateral deviation of the residual femur. Additionally, there is an atrophy and contraction of the muscles surrounding the hip joint. Using TOPS, the patients perform full weight bearing direct to the bone which comes much closer to physiological walking. At the same time, the lateral muscle groups are getting under painful tension. In our study we are going to investigate a correlation between the development of pain enclosing the hip joint and the changed angle of abduction comparing it to the former use of socket prosthesis. We would like to show that physiotherapy in advance might reduce or even eliminate the pain.
Simone Paulyn
Brandes and Diesing, Germany
Title: Physiotherapy for leg- amputated patients in the physiotherapy practice
Biography:
Simone Paulyn is a physiotherapist since 2000 with experiences in hospitals, rehabilitation clinics and private sections. She has been treating amputees since 2005. Since 2017 she is working for Brandes & Diesing in the section of orthopedical mechanics leading the prosthesis gait training section and is part of the TOPS-Team in Hanover which is actually making studies about TOPS and She has published four books as well as many articles in various magazins.
Abstract:
Learning how to walk with the prosthesis is a very important aspect in therapy. A physiological gait should be trained in varying situations of daily life, so that the patient is able to integrate as good as possible into social life. Depending on the reason for an amputation there exist different restrictions for the amputee which require diagnosis-orientated therapeutical actions. With patients of the mobility grade 1&2 the focus is on walking safely, balance and a physiological gait. With patients of the mobility grade 3&4 the focus is more on complex situations of daily life, outdoor and sports. A detailed diagonsis and gait analysis give information which therapy improves the conditions for a physiological gait. A combination of contracture-prophylaxis, PNF, manual therapy, treatment of scarfs, facial therapy, strengthening muscles, core stability, drainage of the lymphatic system, handling of the prosthesis as well as treating phantom pain e.g. With mirror therapy. A very important aspect in rehabilitation is interdisciplinary collaboration. An adequately built prosthesis as well as the exchange between the orthopaedic technician and the physiotherapist lead to a better result. We practice this in our prosthetic gait training in groups in our practice and company in Germany with success.
Ines Llamas-Ramos
University Hospital of Salamanca, Spain
Title: Dry needling in the treatment of de quervain’s tenosynovitis
Biography:
Ines Llamas-Ramos has completed her PhD at The University of Salamanca, Salamanca, Spain. Currently, she is working as a Physiotherapist at the University Hospital of Salamanca and carrying out her clinical practice. She has been working as a Visiting Professor at The University of Salamanca, in the Department of Nursing and Physiotherapy. She has published several articles about cancer and dry needling in reputed international journals and has been serving as an Editorial Board Member of various medical journals.
Abstract:
The patient of this study is a female administrative, she was 57 years old. In her job she always uses the computer and she has a lot of repetitive movements. She referred pain in the first extensor compartment of her right wrist. She went to a physiotherapy clinic and has completed three sessions of conservative treatment (massage therapy and stretching). Two months later she was still having pain and a slight loss of muscle strength in her right arm. She went to another physiotherapy clinic and she received a session consisting in massage in her forearm, wrist articular movement, deep transverse massage in tendons of her first dorsal compartment, ultrasound and stretching. She improved but she was still having pain and inflammation. In the second session the physiotherapist proposed dry needling and the patient accepted. After one session of dry needling, ultrasound and stretching, the final recuperation was achieved. Continued stretching at home was recommended. Six months later the patient is completely asymptomatic. We can conclude that dry needling in the treatment of De Quervain’s tenosynovitis has great benefits in pain, inflammation and muscle and tendon recuperation after repetitive movements as well as its long-term maintenance. A lot of evidence exists about the effect of dry needling in muscles but the application of this technique in one specific tendon improves symptomatology. We thought that this line of research could give physiotherapists great results in the treatment of their patients.
Ines Llamas-Ramos
University Hospital of Salamanca, Spain
Title: Ultrasound added to manual therapy is effective in the treatment of temporomandibular disorders
Biography:
Ines Llamas-Ramos has completed her PhD at The University of Salamanca, Salamanca, Spain. Currently, she is working as a Physiotherapist at the University Hospital of Salamanca and carrying out her clinical practice. She has been working as a Visiting Professor at The University of Salamanca, in the Department of Nursing and Physiotherapy. She has published several articles about cancer and dry needling in reputed international journals and has been serving as an Editorial Board Member of various medical journals.
Abstract:
A female woman, 29 years old, physiotherapist suffering from temporomandibular disorders since, she was 17 years old. She referred pain, functional disorders of the masticatory system, temporomandibular joint and masticatory muscles. She has completed five sessions of therapeutic treatment that includes stretching exercises, passive and active range of motion exercises and strengthening exercises. Each type of exercise was performed for the duration of six seconds and repeated 10 times. She improved but she was still having limitation to open her mouth in her left temporomandibular joint. After consultation with a specialist, he recommended a magnetic resonance. This magnetic resonance showed a temporomandibular disorder type I. She was referred again to rehabilitation service, she performed the same treatment and her physiotherapist added a low intensity ultrasound. After 10 sessions she felt better, her range of motion was increased, her masticatory muscles were relaxed and the pain decreased. It is important to follow this patient, to know how long she keeps the results in order to offer her the best and more complete treatment for her pathology. We can conclude that low intensity ultrasound with manual therapy helps to improve the range of motion, pain and to keep free the temporomandibular joint. It is important to apply a correct treatment to obtain long term results. More studies with more sample size are needed to confirm this hypothesis.
Aleksandra Szylinska
Pomeranian Medical University, Poland
Title: Respiratory capacity as an element of qualification for cardiac rehabilitation among women and men following a cardiac surgery
Biography:
Dr Aleksandra Szylinska (PhD) is a physiotherapist. She works as Assistent Profesor at Department of Medical Rehabilitation and Clinical Physiotherapy. Practical working as a physiotherapist in Cardiac Surgery Clinic with patients early stage after surgery.
Abstract:
Introduction: The cardiac surgery is followed by severe functional depression of the respiratory system. It is caused by many independent factors connected with the surgery itself, extracorporeal circulation and postoperative course, especially mechanical ventilation. Studies confirm that the postoperative course and return to a normal lifestyle is more difficult for women than men. Cardiac rehabilitation has a significant impact on the prevention of complications and mortality after cardiac surgery. Aim: Analysis of spirometry results depending on the sex of the patients qualified for two models of rehabilitation (inpatient or home-based) after cardiac surgery. Materials & Methods: In the Department of Cardiac Surgery, 104 patients admitted to a planned coronary artery bypass grafting were prospectively examined. The patients had a spirometry examination on the day of admission to hospital, and at 5th and 25-30th days after surgery. At the 5th day after surgery (i.e. The day of discharge), patients were randomized into two groups of 52 patients on the basis of spirometry, sex (women and men) and age (≤65 and >65 years). This resulted in two homogeneous groups before the separation. The first group was qualified for the second phase inpatient cardiac rehabilitation at the Cardiac Rehabilitation Department at the Cardiac Surgery Clinic. The second group conducted home-based exercises according to the same exercise program. The last spirometry examination was performed 25-30 days after the surgery. Results: Among the examined women a significantly better final result of spirometry examination was observed in group one (inpatient rehabilitation) than in group two (home-based), considering all women (p<0.001), women under 65 years of age (p=0.011) and those over 65 years of age (p=0.007). Among men, a decrease in the last spirometry result compared to the pre-surgery examination was also significantly lower following inpatient rehabilitation than home-based rehabilitation. The younger group (below 65) had better spirometry results than the older group (>65) but the results were not statistically significant. Conclusion: Lesser decrease in respiratory capacity in the range of forced vital capacity following a cardiac surgery was observed in the group of women and men undergoing inpatient rehabilitation.
Aleksandra Szylinska
Pomeranian Medical University, Poland
Title: Respiratory capacity as an element of qualification for cardiac rehabilitation among women and men following a cardiac surgery
Biography:
Dr Aleksandra Szylinska (PhD) is a physiotherapist. She works as Assistent Profesor at Department of Medical Rehabilitation and Clinical Physiotherapy. Practical working as a physiotherapist in Cardiac Surgery Clinic with patients early stage after surgery.
Abstract:
Introduction: The cardiac surgery is followed by severe functional depression of the respiratory system. It is caused by many independent factors connected with the surgery itself, extracorporeal circulation and postoperative course, especially mechanical ventilation. Studies confirm that the postoperative course and return to a normal lifestyle is more difficult for women than men. Cardiac rehabilitation has a significant impact on the prevention of complications and mortality after cardiac surgery. Aim: Analysis of spirometry results depending on the sex of the patients qualified for two models of rehabilitation (inpatient or home-based) after cardiac surgery. Materials & Methods: In the Department of Cardiac Surgery, 104 patients admitted to a planned coronary artery bypass grafting were prospectively examined. The patients had a spirometry examination on the day of admission to hospital, and at 5th and 25-30th days after surgery. At the 5th day after surgery (i.e. The day of discharge), patients were randomized into two groups of 52 patients on the basis of spirometry, sex (women and men) and age (≤65 and >65 years). This resulted in two homogeneous groups before the separation. The first group was qualified for the second phase inpatient cardiac rehabilitation at the Cardiac Rehabilitation Department at the Cardiac Surgery Clinic. The second group conducted home-based exercises according to the same exercise program. The last spirometry examination was performed 25-30 days after the surgery. Results: Among the examined women a significantly better final result of spirometry examination was observed in group one (inpatient rehabilitation) than in group two (home-based), considering all women (p<0.001), women under 65 years of age (p=0.011) and those over 65 years of age (p=0.007). Among men, a decrease in the last spirometry result compared to the pre-surgery examination was also significantly lower following inpatient rehabilitation than home-based rehabilitation. The younger group (below 65) had better spirometry results than the older group (>65) but the results were not statistically significant. Conclusion: Lesser decrease in respiratory capacity in the range of forced vital capacity following a cardiac surgery was observed in the group of women and men undergoing inpatient rehabilitation.
Iwona Rotter
Pomeranian Medical University, Poland
Title: Comparative analysis of quality of life in patients following unilateral breast cancer surgery depending on the physiotherapeutic method used to reduce swelling
Biography:
Dr Iwona Rotter (MD, PhD) is a medical doctor, specialist in Neurology and Rehabilitation Medicine. She works as Head at Department of Medical Rehabilitation and Clinical Physiotherapy. She has published many papers in refereed journals.
Abstract:
Introduction: Breast cancer is the most common cancer in women. One of the most frequent complications of breast cancer treatment is lymphedema of the upper limb, which significantly worsens the quality of life of patients, which is why it is necessary to find effective methods of reducing edema. Aim of the study: Assessment of quality of life of patients after breast cancer surgery undergoing treatment of upper limb edema with the use of a comprehensive standard anti-edema therapy with ready-made compression products and a therapy modified by kinesiotaping. Material & Methods: We examined 65 patients with lymphedema of the upper limb following breast cancer surgery. Patients were divided into two groups. In group A a complex anti-edematous therapy with kinesiotaping (n=34) was applied, while in group B a compression sleeve was used (n=31). Patient’s quality of life before and after therapy was assessed using the LYMQOL questionnaire. Differences in upper limb circumference before and after the therapy were measured with a tape measure. Each patient underwent 8 complex antiedematous therapy sessions once a week for two months. Results: In both groups an improvement in quality of life was observed according to all domains of the LYMQOL questionnaire before and after rehabilitation (p<0.001). In both group A (kinesiotaping) and group B (compression) mean circumferences of the upper extremity were reduced (p<0.001). No statistically significant differences between the groups were found, except that the patients using the kinesiotaping method were more frequently observed to improve the quality of life in the domain of well-being than those using a compression sleeve (p=0.045). Conclusion: Both antioedematous therapies improved the quality of life and were an effective method to reducelymphedema in patients following breast cancer surgery, but the well-being was much higher in patients using kinesiotaping.
Shannon Ya-Hui Chiu
The Institute of Biomedical Engineering-National Chiao Tung University, Taiwan
Title: Quantitative evaluation of upper limb rehabilitation using an intelligent stacking cone system in a game setting
Biography:
Shannon Ya-Hui Chiu has completed her Master’s degree in the Institute of Biomedical Engineering at National Chiao Tung University. She has excellent engineering training, and is an expert in system integration and automation. She has participated in the design and construction of various medical devices, including an upper limb rehabilitation device, an emulated laser acupuncture system, and the development of near infrared brain activity recording device.
Abstract:
People suffering neurological deficits due to sudden onset of occlusion or rupture of cerebral vessels usually develop multiple clinical symptoms such as hemiplegia, dysesthesia, difficulty in speech or comprehension or defect of visual fields after the acute phase. Specifically, functional impairment of the upper extremities is most common in these patients. It is important to design a suitable training program for individual patient to effectively restore physical functions. However, the current training protocols often rely on manual and subjective assessment of upper extreme functions. In this paper we present the implementation of an “Intelligent Stacking Cone System” that was designed to quantitatively evaluate the functional status of the upper limbs during rehabilitation. The design of a video game setting with a console emulating the famous whac-a mole game can significantly improve patient participation in the rehabilitation program. The system is integrated with many optoelectronic position sensors. During the execution, the system can detect five key timings including the reaction time after a picture prompts, palm grip action, upper limb remove action, palm release action and upper limb return action. The timing differences between these five critical activities are used to represent the dynamic status of the upper limb rehabilitation. The therapist could compare with the past training result to assess explicitly quantified patient progress. Intelligent stacking cone upper limb rehabilitation system is a new design and method for rehabilitation. This system aims to raise the efficacy and fun level during diagnostic and therapeutic procedures, thus improve the outcomes.
Mohammad Kamali Kakhki
Tehran Healthcare Clinic, Iran
Title: The carpal-tunnel syndrome: Experimental works in diagnosis and treatment of fourty-five hands
Biography:
Mohammad Kamali Kakhki has completed his M.D at the age of 25 years from Mashhad University of Medicine and studied in the field of Trigger point therapy, Palpitation anatomy and Massage therapy from Tehran University of Medicine. He works in Tehran Healthcare Clinic (west marzdaran, Tehran, Iran) and has 30 years experimental works on muscle, ligaman and nervous system.
Abstract:
Carpal tunnel syndrome (CTS) is the most common peripheral nerve involvement which entraps the median nerve in a restricted space at the wrist and converts the anterior surface into the osteofacial tunnel. Carpal tunnel is formed by flexor retinaculum and carpal bones which passes the long flexor tendons of the fingers and median nerve through the tunnel. The clinical sign of the syndrome is defined by burning pain, nocturnal numbness and paraesthesia to the lateral three and a half fingers. In severe cases, median nerve innervated muscles weakness can cause numbness in hands. This syndrome may occur in both employed and non-working people even housewife who forceful hand work with their wrists. There are several ways of treatment for CTS including splints, ultrasound, acupuncture, exercise, laser, steroid injections, oral steroid and surgical technique. However, some of these treatments emporarily reduce pain and are not compelling. This problem is due to the lack of knowledge about the cause of syndrome in the body. We found that this syndrome can be created in two different ways in the body: primitive carpal tunnel syndrome which is caused by narrowing of the canal and compression of median nerve and lng flexor tendons. Secondary carpal tunnel syndrome is caused by cervical lesions such as neck osteoarthritis, cervical discs, compression of brachial plexus nerve and this pressure can be transmitted to the tendons of the wrists and fingers. The purpose of the present stu y is to report the experimental works in CTS based on the type of entrapment by Multi-Functional Vibrating Device (MFVD) in Tehran Healthcare Clinic. Forty patients with carpal tunnel syndrome who complain from tingling, burning pain or weakness in one or two of their hands referred to the TehranHealth care Clinic. Of these patien ts, thirty-two women and eight men referred and five of them had syndrome in both hands. First, the type of syndrome was investigated based on the sort of involvement. Then, current age, onset age, the severity of the syndrome and syndrome duration were asked. Afterwards, the treatment was done y vibration stimulation of entrapped flexor or nerve using MFVD during five sessions. The successful treatment of the syndrome was considered through examination of the pain and the flexion of wrist and finger during the wrist-flexion test and gripping, which is related to the brachial plexus nerves and long flexor tendons. Fifteen out of forty-five hands were not treated because they referred to the clinic very late and their syndrome became chronic. So, they require the other methods like surgical technique for treatment. Of the thirty hands treated, nine had primitive CTS and twenty-one had secondary CTS and the recovery were achieved by works on entrapped flexor and brachial plexus nerves, respectively. The patients with primitive CTS were driver, painter, sculptor, chef or housewife who put a lot of pressure on their wrist and the patients with secondary CTS were farmer, cleaner or the other jobs that put a lot of pressure on their necks, shoulders, arms and wrists. The average age of referred patients was between 45 and 60. The duration of the syndrome is very important for treatment. If the duration of the syndrome is short, it can be easily treated by MFVD, but if it is over a long period of time, the treatment is more difficult and in the chronic form, no sign of recovery was observed by vibration stimulation. Although, there are different ranges of treatment in patients with CTS, but the type of CTS have to be considered on the choice of treatment. This treatment method has been an experimental works which showed very good results for both primitive and secondary CTS but non-chronic syndrome. Thus, this method is recommended for treatment of patients with CTS
Mohammad Kamali Kakhki
Tehran Healthcare Clinic, Iran
Title: The carpal-tunnel syndrome: Experimental works in diagnosis and treatment of fourty-five hands
Biography:
Mohammad Kamali Kakhki has completed his M.D at the age of 25 years from Mashhad University of Medicine and studied in the field of Trigger point therapy, Palpitation anatomy and Massage therapy from Tehran University of Medicine. He works in Tehran Healthcare Clinic (west marzdaran, Tehran, Iran) and has 30 years experimental works on muscle, ligaman and nervous system.
Abstract:
Carpal tunnel syndrome (CTS) is the most common peripheral nerve involvement which entraps the median nerve in a restricted space at the wrist and converts the anterior surface into the osteofacial tunnel. Carpal tunnel is formed by flexor retinaculum and carpal bones which passes the long flexor tendons of the fingers and mediannerve through the tunnel. The clinical sign of the syndrome is defined by burning pain, nocturnal numbness and paraesthesia to the lateral three and a half fingers. In severe cases, median nerve innervated muscles weakness can cause numbness in hands. This syndrome may occur in both employed and non-working people even housewife who forceful hand work with their wrists. There are several ways of treatment for CTS including splints, ultrasound, acupuncture, exercise, laser, steroid injections, oral steroid and surgical technique. However, some of these treatments temporarily reduce pain and are not compelling. This problem is due to the lack of knowledge about the cause of syndrome in the body. We found that this syndrome can be created in two different ways in the body: primitive carpal tunnel syndrome which is caused by narrowing of the canal and compression of median nerve and long flexor tendons. Secondary carpal tunnel syndrome is caused by cervical lesions such as neck osteoarthritis, cervical discs, compression of brachial plexus nerve and this pressure can be transmitted to the tendons of the wrists and fingers. The purpose of the present study is to report the experimental works in CTS based on the type of entrapment by Multi-Functional Vibrating Device (MFVD) in Tehran Healthcare Clinic. Forty patients with carpal tunnel syndrome who complain from tingling, burning pain or weakness in one or two of their hands referred to the Tehran Healthcare Clinic. Of these patients, thirty-two women and eight men referred and five of them had syndrome in both hands. First, the type of syndrome was investigated based on the sort of involvement. Then, current age, onset age, the severity of the syndrome and syndrome duration were asked. Afterwards, the treatment was done by vibration stimulation of entrapped flexor or nerve using MFVD during five sessions. The successful treatment of the syndrome was considered through examination of the pain and the flexion of wrist and finger during the wrist-flexion test and gripping, which is related to the brachial plexus nerves and long flexor tendons. Fifteen out of forty-five hands were not treated because they referred to the clinic very late and their syndrome became chronic. So, they require the other methods like surgical technique for treatment. Of the thirty hands treated, nine had primitive CTS and twenty-one had secondary CTS and the recovery were achieved by works on entrapped flexor and brachial plexus nerves, respectively. The patients with primitive CTS were driver, painter, sculptor, chef or housewife who put a lot of pressure on their wrist and the patients with secondary CTS were farmer, cleaner or the other jobs that put a lot of pressure on their necks, shoulders, arms and wrists. The average age of referred patients was between 45 and 60. The duration of the syndrome is very important for treatment. If the duration of the syndrome is short, it can be easily treated by MFVD, but if it is over a long period of time, the treatment is more difficult and in the chronic form, no sign of recovery was observed by vibration stimulation. Although, there are different ranges of treatment in patients with CTS, but the type of CTS have to be considered on the choice of treatment. This treatment method has been an experimental works which showed very good results for both primitive and secondary CTS but non-chronic syndrome. Thus, this method is recommended for treatment of patients with CTS.
Maryam Saadat
Ahvaz Jundishapur University of Medical Sciences, Iran
Title: The effects of combining traditional physical therapy exercises with sensorimotor training on clinical outcomes of patients with chronic non-specific neck pain: A doubleblind, randomized controlled trial
Biography:
Maryam Saadat is from Ahvaz Jundishapur University of Medical Sciences, Iran.
Abstract:
Objective: This study examined the effects of combining traditional physical therapy exercises with sensorimotor trainings on joint position sense, pain, muscle endurance, balance and disability in patients with chronic non-specific neck pain. Design: Double-blind, randomized controlled trial. Subjects & Interventions: A total of 53 patients with chronic non-specific neck pain were randomized to either traditional or combined exercise groups. All patients received 12 sessions supervised intervention, 3 times per week. The traditional group received traditional exercises but the combined exercise group performed sensorimotor training in addition to traditional exercises. Outcome measures: Joint position sense, pain, neck flexor muscle endurance test, 10 Meter Walk Test, step test, and Neck Disability Index Results: The combined exercise group showed significantly greater improvement at joint position sense in extension, flexion, right rotation, 10 meter walk test with head turn and step test compared with the traditional group. Pain intensity, muscle endurance, and disability improved in both groups. However, the effect size of muscle endurance was large for the combined exercise group whereas moderate for traditional group. Conclusions: Combination of sensorimotor training to the traditional physical therapy exercises could be more effective than traditional exercises alone in improving joint position sense, endurance, dynamic balance and walking speed.
Mohammad Hassan
Baqai Medical University, Pakistan
Title: Awareness of text neck syndrome in young-adult population
Biography:
Mohammad Hassan is from Baqai Medical University, Pakistan.
Abstract:
Text neck is a repeated stress injury and pain sustained from excessive watching or texting on handheld devices for long periods of time. Dependence of mobile phone is increasing rapidly and people spend long hours on mobile phone that lead to various musculoskeletal problems. This study will help us find the awareness of text neck syndrome and awareness of hazards which are caused by excess usage of phone. This study also aimed at finding the knowledge regarding the preventive measures of text neck syndrome. The study design was an observational study with a sample size of 311. A self-administered questionnaire was distributed to all subjects. Results were calculated in percentile format. This study stated that 35% population has heard of text neck syndrome out of which only 8% population has knowledge of this syndrome. The results also stated that 21% population have knowledge regarding the preventive measures of this syndrome. This study has demonstrated a low level of awareness of text neck syndrome amongst young adult population. Also it mentioned about lack of knowledge of preventive measures in this population.