Day 1 :
Keynote Forum
Raymond Chong
Augusta University,USA
Keynote: Postural Adaptation to Somatosensory Conditioning
Time : 10:10-10:15
Biography:
Dr. Raymond Chong is the Chair of the Department of Interdisciplinary Health Sciences as well as the director of the Applied Health Sciences PhD program. He completed his PhD in 1997 from the University of Oregon. He is the lead author in over 60% of his papers. Dr. Chong is a regular reviewer for the US Veteran Affairs Research department and also serves on the editorial board of several journals including Gait & Posture.
Abstract:
The ability to flexibly adapt one's postural orientation and equilibrium is important for sports and activities of daily living. One method of studying postural adaptation is to perturb the sensorimotor set of subjects and observe how they reset their posture. Here in a series of experiments, we applied somatosensory conditioning by having subjects stand blindfolded on a toes-up inclined surface for several minutes (inclined phase). When healthy adult subjects were returned to a level surface (post-inclined phase), a range of postural adaptation was observed. On one extreme, subjects showed a large aftereffect of the prior inclined stance by leaning their body forward. Other subjects did not display the aftereffect. Instead, they remained standing upright. Individuals with Parkinson's disease also showed a normal range postural adaptation. Those with a cerebellar disorder adapted normally but all presented with high postural sway variability during the post-incline phase. Finally, individuals with a vestibular disorder all showed the aftereffect (i.e., all were responders) whereas among subjects with a somatosensory deficit (neuropathy in the legs and feet), all except one remained standing upright (i.e., all except one were non-responders). High postural sway variability was also observed in the subjects. These results increase our understanding of how postural control is reset following somatosensory conditioning in healthy and impaired populations. It appears that being a responder or non-responder is largely a function of whether the somatosensory or vestibular system predominates the natural sensory integrative mechanism of each individual. In subjects with a vestibular deficit, postural control is deferred to the somatosensory system as evidenced by the forward body lean during the post-inclined phase. On the other hand, the absence of the lean aftereffect in subjects with a somatosensory deficit indicates the natural preference to align posture to gravity via vestibular inputs. Rehabilitation should be focused on increasing patient awareness of the environmental factors that increase their risk of falls secondary to vestibular or somatosensory deficits. Therapists can incorporate interventions to improve the integration or dominance of the underperforming sensory system, provide strategies for ambulating across uneven or shifting terrain, or modifying their surroundings.
Keynote Forum
Areerat Suputtitada
Chulalongkorn University & King Chulalongkorn Memorial Hospital,Thailand
Keynote: Transcranial Direct Current Stimulation(tDCS) for Neurorehabilitation
Time : 10:15-11:00
Biography:
Dr. Areerat Suputtitada is Professor of Rehabilitation Medicine, full time working faculty at Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, advisor of the editorial board of Thai Rehabilitation Medicine Journal, and an educational board member of Exercise and Health Promotion in the Ministry of Public health. She received 15 national awards, 3 international awards, and published more than 20 international and 30 national articles in the areas of her experts including neurological rehabilitation, spasticity and dystonia, gait and motion, and pain. She has also been invited to lecture and act as a chairman for over 70 international conferences. Dr. Suputtitada has been elected and appointed to important positions in the International Society of Physical and Rehabilitation Medicine (ISPRM) such as the Chair of Women and Health Task Force and International Exchange Committee. Moreover, she is the youngest physician to have won the Fund Award for Professorship in Thailand
Abstract:
Transcranial Direct Current Stimulation (tDCS) has increasingly purposive treatments for neurorehabilitation, compared to other noninvasive neuromodulations. It is inexpensive, safe, easy to administer after well trained, portable, and home used design considered as the most cost effective and good compliance therapy. It can either enhance or suppress cortical excitability by a weak and constant direct current applied to the brain. It has effect for several hours after the stimulation, depending on several factors. Three different stimulation types are as the followings;
(1) anodal stimulation, the anodal electrode (+) and the reference electrode are applied over the lesioned brain area and the contralateral orbit, respectively. It effects subthreshold depolarization, producing neural excitation.; (2) cathodal stimulation, the cathode (−) and the reference electrode are applied over the non-lesioned brain area and the contralateral orbit, respectively. It effects subthreshold polarization, suppressing neural activity.; (3) Dual tDCS, anodal and cathodal stimulation, the anodal electrode (+) and the cathodal electrode (−) are applied over the lesioned and non-lesioned brain, respectively. In clinical use, two (or more) electrodes are applied over the scalp with the current flowing from the anodal to the cathodal electrode. The strength of electrical currents cannot produce an action potential. The factors influence neural activity including the state of the brain during stimulation at rest or stimulation and relearning with a task in the meantime, and even the time of the day. There are increasing evidences of tDCS effect on the whole brain networks by stimulating just one brain region. The positive clinical effects of tDCS in various disorders are caused by the complex interactions between the associated brain network and the area of stimulation. Interestingly, stimulation at the dorsolateral prefrontal cortex (DLPFC), have shown the effectiveness for several conditions. On the other hand, different area of stimulation for the same disorder have shown to have similar results. These new evidences may indicate an underlying neural network for disorders and may suggest network stimulation as a new stimulation protocol.
Current evidences do not recommend Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is revealed for: (i) anodal electrode applied at the left primary motor cortex (M1) and cathodal electrode applied at the right orbitofrontal area in fibromyalgia; (ii) anodal electrode applied at the left dorsolateral prefrontal cortex (DLPFC) and cathodal electrode applied at the right orbitofrontal area in major depressive episode without drug resistance; (iii) anodal and cathodal electrode applied at the right and left DLPFC, respectively in addiction/craving. Level C recommendation (possible efficacy) is revealed for anodal electrode applied at the left M1 or contralateral to pain side and cathodal electrode applied at the right orbitofrontal area in chronic lower limb neuropathic pain secondary to spinal cord lesion.
However, Level B recommendation (probable inefficacy) is extended to the absence of clinical effects of: (i) anodal electrode applied at the left temporal cortex and cathodal electrode applied at the right orbitofrontal area in tinnitus; (ii) anodal electrode applied at the left DLPFC and cathodal electrode applied at the right orbitofrontal area in drug-resistant major depressive episode.
Whether there is a potential effect when combining tDCS, with intensive physical therapy, constraint- induced therapy, robot-therapy, EMG-triggered functional neuromuscular stimulation is increasing evidences. The evidences revealed combining approaches enhancing adaptive plasticity and limiting maladaptive plasticity according to the stage of the disease, pharmacological, electrophysiological or physical adjuvant therapy could
theoretically improve the patients’ care, and given the disease complexity, should ultimately favor a patient-tailored approach.
In conclusion, Non-invasive stimulation technique as tDCS have the potential to modulate brain cortical excitability with long lasting effects which promising enhance neurorehabilitation. More researches are upcoming in various indications and stimulation protocols.
Keywords: Transcranial Direct Current Stimulation (tDCS), brain cortical excitability, neurorehabilitation
- Physical Therapy Science | Physiotherapy in sport related injuries | Advancement in Physiotherapy | Manual & Manipulative Therapy | Artificial Physiotherapy Methods
Session Introduction
Deepak B. Anap
Maharashtra University of Health Sciences,India
Title: Effectiveness of sustained natural apophyseal glides and Maitland’s mobilization in facet joint syndrome: a randomized control trial
Biography:
Dr. Deepak B. Anap, Professor & Head, Department of Musculoskeletal Physiotherapy, D.V.V.P.F’s College of Physiotherapy, Ahmednagar – 414111
Abstract:
Background: Low back pain is a major cause of disability affecting performance at work. One of the hidden and less studied culprit of chronic low back pain is facet joint syndrome. Currently, there is paucity in the literature regarding the effectiveness of physiotherapy techniques in treating facet joint syndrome. Hence this trial was undertaken to study the effectiveness of passive accessory intervertebral movement (PAIVM) such as Maitland’s mobilization and passive sustained accessory mobilization, such as Mulligan’s technique (SNAGs) along with conventional physiotherapy intervention as compared to conventional physiotherapy in facet joint syndrome.
Method: A single-blind, randomized control trial was conducted on participants diagnosed with lumbar facet joint syndrome. Outcome measures for the study were Visual analogue scale (VAS), Modified oswestry disability questionnaire (MODQ), Pressure pain threshold(PPT), Back muscle endurance, Spinal flexion and extension ROM. After baseline assessment, participants were randomly assigned to Group A which received Mulligans Sustained natural apophyseal glides (SNAG’S), therapeutic ultrasound (Cont.1MHz, 1.5W/cm2) and spinal exercises, Group B received Maitland’s spinal mobilization (PA Glides), therapeutic ultrasound and spinal exercises and Group C received therapeutic ultrasound and spinal exercises for the period of 2 Wks. Follow up was done at 3rd wk.
Result: Total 186 participants were analyzed using Kruskal-Wallis test and Dunn-Bonferroni post hoc Test.K-W test showed a significant difference in all three groups in terms of VAS, MODQ, PPT and Spinal ROM. Post Hoc test showed the significant difference (p <0.001) between SNAGs and Maitland Group in terms of flexion and extension ROM and there was no significant difference (p>0.05) between SNAGS and Maitland’s manual therapy groups in terms of pain, MODQ and PPT.
Conclusion: SNAGs is more effective in improving spinal ROM, however SNAGs and Maitland’s spinal mobilization are equally effective in reducing pain, disability and improving pressure pain threshold. Back muscle endurance improved in all the three groups, but the difference was not statistically significant.
Key words: Facet Syndrome, Sustained Natural Apophyseal Glides, Maitland’s Mobilization, Pressure pain threshold
Shwufen Wang
National Taiwan University, School of Physical Therapy, Taiwan
Title: Decrease of Range of Motion in Hip rotation in Patients with Unilateral Low Back Pain
Biography:
Shwufen Wang has completed his PhD from Medical College of Virginia, Virginia Commonwealth University. She is currently Professor in School of Physical Therapy, National Taiwan University. Her research insterest is on pain mechanism and pain management of chronic spinal pain in relation to core muscle stability and spinal integrity.
Abstract:
Chronic low back pain is high prevalent and become economic burden in the modern society. The current model of pain managemnt adapted a bio-psycho-social concept to understand the possible mechanism, and generating novel intervention. Tradition anatomy of muscular skeletal system focuses on the morphology of individual muscles and joints. However, the concept of bio-psycho-social model challenges the traditional concept. The net-work concept of the bio-psycho-social system provides the possibility of interaction among systems. The concet of biotensegrity connecting by fascia network provides a paradygmn shift in viewing the human body. We thus hypothese that patients with chronic unilateral low back pain, with possible imbalance tension in the myofascial network of the low back will result in asymmetrical movement of adjacent hip joint in three dimentaion, particularly in rotation. The purpose of this investigation is to compare the hip rotation in patients with unilatral low back pain and asymptomatic control. 19 patietns with unilatral low back pain and 24 asymptomatic participants were recruited. The exclusion criteria are leg length descrepency, and scoliosis. The hip rotation was measured in prone position with the knee in flexion position for both legs. The repetitive ANOVA (group*side* rotation) was run. The result showed interaction between side and rotation. The left side has significantly less internal rotation. The significant group effect showed the patients has significantly less rotation in internal and external of both legs. For both patients and asymptomaitc participants, left interal rotation is more limited than the right side. The results indicated that the limition of the hip rotation in both internal and exteranl direction in both legs in patients with unilateral low back pain, and support the net-work concept of muscular skeletal system, while pain in the low back related to adajecent hip joints in rotation bilaterally.
Abhijit Merekar
Vikhe Patil Foundation, India
Title: Vitex Nirgundo Phonophoresis – A Key for Pain free life in Knee Osteoarthritis
Biography:
Prof. Dr. Abhijit Narayanrao Merekar is currently working as Associate Professor, Department of Pharmaceutics at Dr.Vithalrao Vikhe Patil Foundation’s, College of Pharmacy, Ahmednagar-414111 (INDIA). He has completed his Ph.D. with research on Antihypertensive drugs. He has published more than 29 research papers. He has also attended 17 national and state level seminar and 35 poster presented. He received long term research grant from Savitribai Phule Pune University (formerly University of Pune and University of Poona) for his research on treatment of cancer by wheat grass Juice. He received various prestigious awards in multidisciplinary research.
Abstract:
Background: Osteoarthritis is a progressive disease. It is the “most common form of joint disease in the world” (Merck, 2002). Various invasive and noninvasive treatments are available for OA knee management. Physiotherapy along with pharmacological management can prove better outcomes in Knee pain cases. Objective of our study was to find out effectiveness of Diclofenac sodium phonophoresis and Vitex Nirgundo phonophoresis along with knee exercises in Osteoarthritis.
Method: In this Randomized control trial, 32 diagnosed cases of Grade II knee osteoarthritis without any other knee pathology were divided in two groups using computer generated random numbers. First group was treated with Diclofenac sodium phonophoresis along with Quadriceps strengthening and active knee exercises and second group was treated with Vitex Nirgundo Oil phonophoresis along with Quadriceps strengthening and active knee exercises for 2 weeks. Outcome measures such as Pain (VAS score) and WOMAC score was assessed at baseline and at the end of 2 weeks.
Results: On analysis using unpaired t Test showed significant difference in two groups (p<0.005). Pain intensity and Knee disability using MODQ score showed more improvement in Group two. (i.e. Vitex nirgundo group).
Conclusion: Vitex Nirgundo Oil phonophoresis along with physiotherapy is more beneficial than diclofenac sodium phonophoresis in knee osteoarthritis cases.
Abhijit Diwate
Vithalrao Vikhe Patil Foundation’s College of Physiotherapy,India
Title: Effect of different body positions on lung dynamic functions in healthy young non-obese subjects
Biography:
Dr.Abhijit Diwate, Professor and Head, Department of Physiotherapy in Cardiovascular & Respiratory Sciences, Dr. Vithalrao Vikhe Patil Foundation’s College of Physiotherapy, Ahmednagar – 414111, Maharashtra, India. University: Maharashtra University of Health Sciences, Nashik
Abstract:
BACKGROUND:
Frequent changes in body position and avoidance of prolonged period in any single position will minimize the risk of cardiorespiratory complications. Body positioning has potent and direct effect on cardio respiratory functions and dynamics. Hence the purpose of study was to find out effect of different body positions on lung dynamic functions and apply the results of study in a large population for therapeutic purpose.
METHODOLOGY:
50 young healthy non-obese subjects (29 females and 21 males) between are group 18-30 years were selected and Pulmonary Function Tests were done in six different positions (sitting upright, Reclined Sitting (crook), Supine, Prone, Right and Left Side Lying) in a Cardiorespiratory Laboratory of a Superspeciality Hospital. FVC, FEV, PEER, PIFR, FEV1, FVC, FEF 25-75%, SVC, VE, Vt, Vt/Ti and MVV were measured in six different positions. All the data was statistically analyzed and results were documented.
RESULT:
There was statistical significant reduction in PFT parameters in all recumbent positions compared to upright positions (p<0.0033).Further, prone position showed significantly higher flow rates and lung volumes when compared with supine position.
CONCLUSION:
Hence we conclude that reference standard position of Upright sitting was the best position among all other positions. Subsequently, prone position was found to be more physiological than supine position.
KEY WORDS:
Body Positioning, Lung Dynamics, Prone, Spirometry, PEFR.
Maria Muno
Kundiawa General Hospital, Kundiawa Simbu Province Papua New Guinea
Title: Role of Physiotherapy in the Management of Pott’s Disease at Kundiawa General Hospital, Simbu Province Papua New Guinea
Biography:
Maria Muno is 28 years’ old female from Simbu Province Papua New Guinea. Iam a Physiotherapist working in Kundiawa General Hospital Simbu Province. I graduated in Divine Word University with Bachelor Degree in Physiotherapy in 2012 and worked in the Government hospital for 7 years. I was working with Surgeons and Medical Officers with TB of Spine Patients for 7 years now. I did a clinical research on the physiotherapy treatments for spine patients in the hospital and wish to do my presentation.
Abstract:
Pott’s disease also known as spinal tuberculosis(TB) which commonly leads to a gradual onset of neurological deficits. Tuberculosis is on rise in the developing countries as in Papua New Guinea. Kundiawa General Hospital is one of the hospitals in the country which is currently managing Pott’s disease with specific Physiotherapy methods and techniques over the last 20 years. Retrospective analysis of 253 patients documented 158, from medical admission records, years 1996 to 2018. Physiotherapy Intervention were based on: Clinical examination, Spine x-ray, Neuromuscular skeletal assessment (Frenkle, s Grading). Total of 253 of Pott’s diseases patients, 158 were documented, out of that figure 63 patients with neurological deficits and paravertebral abscess underwent surgery, Physiotherapy and Anti-tuberculosis treatment and have benefited well. The other 95 patients without neurological deficits were on pure Physiotherapy and Anti-Tuberculosisand also benefited. Thorough Physiotherapy Neuromuscular skeletal assessment contributes the successful management of the spine and limbs using treatment methods of back care, log rolling techniques , back extension , stimulations exercises and power exercises program of the back and limbs. Patients with gibbous underwent distraction of bilateral uppers and lower limbs by distracting the spine. Majority of patients benefited well with early physiotherapy interventions and discharged home with POP corsets. Most 154 (94.2%) of them have walked and lived a normal live at home after full physiotherapy rehabilitation program with the awareness and continuity of Community based rehabilitation program. It has been a successful multi - disciplinary approach of surgical, medical, physiotherapy, nursing and family was involved.