理学療法と理学リハビリテーションのジャーナル

Background and Introduction: Mobility and cognition assessments are performed in both clinical and basic research settings on a daily basis. During a 24-hrs time span our physiology and physical performance undergo radical changes as we are influenced by the circadian rhythm. The time-of-day interaction on mobility and cognition is unknown in elderly. The aim of this study was to investigate the time-of-day effect on community dwelling elderly population.

Methods: Mobility and Cognition were assessed in 60 elderly using the four outcome measures, including; Modified Mini Mental Status Examination, Berg Balance Scale, Four Square Step Test and Timed Up and Go Test. The participants underwent the same test at three different timings of the day (9:00 am, 1:00 pm and 5:00 pm) and a comparison was done among the three scores of each outcome measure.

Results: An overall significant time-of-day (between 9 a.m. and 5 p.m.) effect was observed for mental status, balance, agility and gait. The variation among the scores was mostly pronounced from midday (1:00 p.m.) toward the evening (5 p.m.) in all four outcome    measures. Specifically between 1:00 p.m. and 5 p.m. more significant difference between the mean values are observed as compared to that between 9:00 am and 1:00 pm.

Conclusions: This study demonstrates that time-of-day influences mobility and cognition in community dwelling elderly population. These findings have important scientific and clinical relevance, as they imply that time-of-day should be a controlled factor when assessing and also when treating cognition, balance, agility and gait.

Title: Can Quantitative Balance Measures discriminate between Functional Ambulation Categories in Chronic Stroke Survivors?

Background: The limited walking ability that follows a stroke restricts a patient’s independent mobility about the home and community, a significant social handicap. This study investigated the relationship between quantitative balance indices and functional ambulation level in stroke patients. The purpose was to explore whether we could provide supportive laboratory evidence for the association between balance and ambulatory level in stroke patients based on computerized dynamic post urography.

Study design: Cross-sectional, observational, descriptive study

Setting: Physiotherapy department in a tertiary care center in Mumbai

Participants: 40 ambulatory stroke patients (mean age = 54.07 ± 11.9 years)

Main outcome measures:

1) Static and dynamic balance was assessed using computerized force plate system

2) Functional ambulation level was determined using Modified Hoffer functional ambulation classification (FAC).

Results: According to FAC, 29.26% of the patients were community walkers. One way ANNOVA showed that static and dynamic balance indices were significantly different with functional ambulation categories. Weight bearing asymmetry during quiet stance (p<0.04); COG sway velocity (p<0.04), weight transfer time (p<0.04) and rising index (p< 0.02) during sit to stand can discriminate between household and community ambulators.

Conclusion: Balance is a significant factor in the attainment of independent functional ambulation in chronic stroke patients. The functional mobility capability of stroke patients may be quantified analytically using static and dynamic balance indices. The key balance factors identified through this study need to be specifically targeted for training and as outcome measures while monitoring the progress of patients through different functional ambulation categories. Results of this study offer a quantitative method of relating the social disadvantage of stroke patients to the impairments.

Background: Knee osteoarthritis is a prevalent musculoskeletal condition affecting older people. Physiotherapy treatment options include conventional physiotherapy which comprised of strengthening and stretching exercises and other is, manual techniques. The purpose of this study was to compare the effectiveness of Mulligan Mobilization with Movement along with Conventional Physiotherapy and McKenzie exercises with Conventional Physiotherapy in knee osteoarthritis.

Method: Subjects were screened using inclusion and exclusion criteria and a written informed consent was obtained from the participants. 60 eligible subjects were divided into 2 groups using simple random sampling method. In Mulligan Group, subjects received Mulligan mobilization with movement along with conventional physiotherapy & McKenzie Group received McKenzie exercises along with conventional physiotherapy. The subjects were assessed  for outcome measures with the help of Knee osteoarthritis & outcome score(KOOS) Index, Time up & go test(TUG), Range of motion of knee joint & Manual muscle testing(Modified Research Council Scale)  at baseline, 4^th week and after 3 months.

Results: Repeated measure ANOVA with post hoc Tukey- Kramer multiple comparison tests were used to find out the significant difference within the group. While unpaired t test was used to find out the difference between two groups. Within group analysis showed significant improvement in all outcome measures in Mulligan group and McKenzie group (p>0.05). After comparing two different methods we found that there was no significant difference between two groups (p<0.05).

Conclusion: - McKenzie exercises and Mobilization with movement technique are equally effective in improving functional outcome and knee range of motion In other hands McKenzie exercises are more effective in improving knee extensor strength.