^{7th International Conference & Exhibition on} Physiotherapy & Physical Rehabilitation March 25-26, 2019
Rome, Italy

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.

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 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.

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 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.

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 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.

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 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.

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 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.

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.

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..

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.

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 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.

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 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.

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.

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 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.

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 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.

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.

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