Effect of proprioceptive neuromuscular facilitation D2 flexion and breathing exercises on lymphedema without a short stretch compression bandage

[Purpose] The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation (PNF) D2 flexion and breathing exercises in a patient with lymphedema (LE). [Subject] This report describes a 57-year-old woman with LE in whom a short-stretch compression bandage (SSCB) could not be used for treatment because of skin itching and redness. [Methods] The patient received complex decongestive therapy without a SSCB. Next, PNF D2 flexion and breathing exercises were conducted three times per week for 14 weeks (36 times). [Results] As a result, the circumference of the armpit was reduced by 0.5 cm; that of 10 cm above the elbow, by 1 cm; that of the elbow, by 0.5 cm; that of 10 cm below the elbow, by 1 cm; and that of the back of the hand, by 0.5 cm. A total of 100 mL (9.4%) of body water was eliminated from the right upper extremity, and moisture ratio was reduced by 0.005%. Finally, range of motion was improved to 20° flexion, 60° abduction, 40° external rotation, and 10° internal rotation. [Conclusion] This study showed that PNF D2 flexion and breathing exercises were effective in reducing LE and improving range of motion.     

Anti-inflammatory and analgesic effects of low-level laser therapy on the postoperative healing process

[Purpose] This study aimed to evaluate the anti-inflammatory and analgesic effects of intraoral application of low-level laser therapy (660 nm) to control pain, swelling and interincisal opening following the extraction of mandibular third molars. [Subjects and Methods] Ten patients underwent removal of lower third molars using the same surgical protocol and pharmacological approach. In the postoperative period, all patients received four consecutive daily sessions of low-level laser therapy, beginning 24 hours after the surgery. Intraoral applications using the diode laser with 660 nm wavelength in the continuous scan mode were performed covering the entire surgical area, which was divided into four quadrants, each of 1 cm² area at a distance of 1 cm. The energy applied at each point was 5 J/cm² during 8 seconds. [Results] The swelling and interincisal opening returned to normal 24 hours after the first low-level laser therapy application (Friedman test). Moreover, the pain intensity was reduced on the third postoperative day, according to the Friedman test. [Conclusion] Low-level laser therapy (660 nm), at the dosimetry used in this study, was effective in reducing postoperative pain and swelling following oral surgery.Key words: Low-level laser therapy, Rehabilitation, Inflammation     

Low-level laser therapy for the treatment of superficial thrombophlebitis after chemotherapy in breast cancer patients: a case study

[Purpose] We report the case of a breast cancer patient with superficial thrombophlebitis treated with low-level laser therapy. [Case] The patient was a 66-year-old women who developed superficial thrombophlebitis in the left upper limb after chemotherapy. She was administered 6 sessions of low-level laser therapy. [Result] Her pain score decreased by 8 points. Her scores on the Patient and Observer scar Assessment Scale decreased by 18 points for the observer portion and by 26 points for the patient portion. [Conclusion] Low-level laser therapy is effective for the reduction of pain and the size of scar tissue in patients with superficial thrombophlebitis.Key words: Superficial thrombophlebitis, Low-level laser therapy, Pain     

Effect of exercise at light loads with manipulative resistance on infraspinatus,trapezius (upper fiber) and deltoid (middle fiber) muscle activities in shoulder joint elevation

[Purpose] To clarify rotator cuff muscular activity in the raised position of the closed kinetic chain (CKC) exercise. [Subjects] Twenty-nine cases were studied, 19 men and 10 women (average age 21.5 ±4.7 years old, average body weight 60.1 kg ±11.4). [Methods] To determine the effects of the closed kinetic chain exercise on the upper limb, we measured the surface EMG of the infraspinatus muscle, the trapezius (upper fiber) and the deltoid (middle fiber) with the arm elevated. [Results] Our results show that at an elevation angle of 150° in the scapular plane of the upper limb, with 5% body weight load, the EMG activities of the infraspinatus muscle are approximately 30% of maximum voluntary contraction (MVC). [Conclusion] The raised position of the CKC exercise is effective in physical therapy for functional recovery of the infraspinatus muscle.Key words: Shoulder joint, IEMG, CKC     

Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema

[Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema.Key words: Breast cancer, Manual lymphatic drainage, Post mastectomy lymphedema     

Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients

[Purpose] The aim of this study was to examine the effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients. [Subjects and Methods] Fifteen stroke patients with no visual or cognitive problems were enrolled. All subjects received robot-assisted therapy and comprehensive rehabilitation therapy for 30 minutes each. The experimental group received a conventional therapy and an additional half hour per weekday of robot therapy. The patients participated in a total of 20 sessions, each lasting 60 minutes (conventional therapy 30 min, robot-assisted therapy 30 min), which were held 5 days a week for 4 weeks. [Result] The patients showed a significant difference in smoothness and reach error of the point to point test, circle size and independence of the circle in the circle test, and hold deviation of the playback static test between before and after the intervention. On the other hand, no significant difference was observed in the displacement of the round dynamic test. The patients also showed significant improvement in the Fugl-Meyer Assessment and Modified Barthel Index after the intervention. [Conclusion] These kinematic factors can provide good information when analyzing the upper limb function of stroke patients in robot-assisted therapy. Nevertheless, further research on technology-based kinematic information will be necessary.Key words: Robot-assisted therapy, Stroke, Upper limb     

Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report

[Purpose] We report our experience with a patient with a central spinal cord injury who showed improved finger and upper limb functions after long-term treatment with a combination of rehabilitation and botulinum toxin type A. [Participants and Methods] The patient had spasms and pain that gradually became more profound and was given botulinum toxin type A at 1 year 3 months after sustaining a spinal cord injury. We administered 14 botulinum toxin type A injections periodically for 7 years 4 months after the injury. We administered the injections at an average interval of 5.6 months. Splints that allowed extension and improved finger muscle tone and contracture were made for the patient. [Results] The patient experienced gradual alleviation of the spasms in the proximal upper limb muscles and improved range of motion after receiving five doses of botulinum toxin type A. The spasms and range of motion in the fingers gradually improved around 4 years after the injury through splint therapy and a combination of botulinum toxin type A administration and rehabilitation. [Conclusion] The combination of botulinum toxin type A, splint, and rehabilitation therapies can lead to positive improvements in finger spasticity and range of motion and is recommended for hypertonia cases with severe contractures.Key words: Carry-over effect, Concomitant use of splint, Restoration of hand function     

Efficacy of multi-wave locked system laser therapy on nerve regeneration after crushing in Wister rats

[Purpose] To investigate the efficacy of the multi-wave locked system laser therapy on the regeneration of peripheral nerve injuries by evaluating the functional, electrophysiological, and morphological changes of the crushed sciatic nerve in Wistar rats. [Materials and Methods] Sixty male Wistar rats (200–250 g) were randomly assigned to control negative, control positive, or laser groups and subjected to no laser therapy or crushing, to crushing without laser therapy, or crushing followed by multi-wave locked system laser therapy five times/week for four weeks (power=1 W, energy density=10 J/cm², total energy=100 J), respectively. Functional, electrophysiological, and morphometric analyses were performed before and 7, 15, 21, and 28 days after crushing. The sciatic functional index, compound motor action potential amplitude, motor nerve conduction velocity, and nerve and myelin sheath diameters were measured. [Results] The sciatic functional index value decreased significantly, while the compound motor action potential amplitude, motor nerve conduction velocity, nerve diameter, and myelin sheath diameter increased significantly in the laser group post-treatment compared to the values in the control groups. [Conclusion] Multi-wave locked system laser therapy was effective in accelerating the regeneration of crushed sciatic nerves in Wistar rats.     

Physical therapy education in Saudi Arabia

[Purpose] To review the physical therapy educational program model, professional curriculum, and gender representation at major universities, as well as the quality and scope of physical therapy practice in Saudi Arabia. [Methods] Information regarding course curriculum, gender representation, and the quality and scope of physical therapy practice was collected from six universities in Saudi Arabia, the Saudi Physical Therapy Association, and the Saudi Health Commission. [Results] The first bachelor’s degree course of physical therapy was started in Saudi Arabia more than 30 years ago. In the last 10 years, the number of universities offering a bachelor’s degree in physical therapy has risen from 6 to 16, of which 14 are governmental and two are private. The 5- to 6 year bachelor’s degree program in physiotherapy includes an internship and preparatory prerequisite courses. Postgraduate study in physical therapy was introduced in 2000. Most universities offer segregated physical therapy courses for male and female students. [Conclusion] The enrollment of students in physical therapy programs in Saudi Arabia is gradually increasing. There are many opportunities to extend the scope of practice and contribute to the health needs of the Arab population and international communities.Key words: Physical therapy, Education, Curriculum     

Twice-weekly complete decongestive physical therapy in the management of secondary lymphedema of the lower extremities

BACKGROUND AND PURPOSE: This case report describes the physical therapist examination, evaluation, and intervention for a patient with bilateral lower-extremity lymphedema who received complete decongestive physical therapy 2 days per week instead of the recommended daily frequency. CASE DESCRIPTION: The patient was a 55-year-old woman who developed bilateral lower-extremity grade II lymphedema 3 years after surgery and radiation for cervical cancer. She had impairments in hip and knee flexion range of motion and functional limitations in transfers, gait, and activities of daily living. Intervention. A twice-weekly intervention program was implemented consisting of education in skin care, manual lymph techniques, compression, and exercise. OUTCOMES: Outcomes related to the lymphedema were measured using the sum of the circumference of each limb. At discharge, the patient had reductions in lymphedema of 9% for the left lower extremity and 10% for the right lower extremity. Her hip flexion range of motion increased from 95 degrees to 110 degrees, and her knee flexion range of motion increased from 95 degrees to 130 degrees. She had resumed all premorbid activities and was independent in self-management. DISCUSSION: Twice-weekly management of lymphedema using a program of skin care, manual lymph techniques, compression, and exercise was followed by reduction of the impairments and functional limitations in a patient with bilateral lower-extremity lymphedema.     

Congenital lymphedema of the upper extremity. A case report

This study presents an unusual case of primary lymphedema of the upper extremity in a healthy 28-year-old woman. The onset of swelling of the left upper extremity was observed at birth, but was not accurately diagnosed until the patient visited our department. Diagnostic assessment included evaluating the patient's history and laboratory and radiological data, which were all normal except for the swollen upper extremity and the lymphoscintigraphy findings. The patient was diagnosed as suffering from primary lymphedema of her left arm. Complete decongestive therapy was done and her swelling mildly improved.     

Comparison between Trans-Cranial Electromagnetic Stimulation and Low-Level Laser on Modulation of Trigeminal Neuralgia

[Purpose] To determine which of the transcranial electromagnetic stimulation or low level laser therapy is more effective in the treatment of trigeminal neuralgia of multiple sclerosis patients. [Methods] Thirty multiple sclerosis patients of both sexes participated in this study. The age of the subjects ranged from 40 to 60 years and their mean age was (56.4–6.6). Participants were randomly selected from Dental and Neurology Outpatient Clinics at King Khalid Hospital, Najran University, Saudi Arabia. Patients were randomly divided into two equal groups of 15. The Laser group received a low level laser therapy, 830 nm wavelength, 10 Hz and 15 min duration, while the Electromagnetic group received repetitive transcranial electromagnetic stimulation at a frequency of 10 Hz, intensity of 50 mA and duration of 20 minutes. Patients were assessed pre and post treatment for degree of pain using a numerical rating scale, maximal oral mouth opening using a digital calibrated caliper, masseter muscle tension using a tensiometer and a compound action potentials of masseter and temporalis muscles. [Results] There were significant improvements after treatment in both groups, with a significant difference between the Electromagnetic and Laser groups, in favor of the Electromagnetic group. [Conclusion] Repetitive transcranial electromagnetic stimulation at 10 Hz, 50 mA, and 20 minutes duration is more effective than low level laser therapy at reducing trigeminal pain, increasing maximum oral mouth opening, masseter and temporalis muscle tension in multiple sclerosis patients.Key words: Trigeminal neuralgia, Low level laser, Trans-cranial electromagnetic stimulation     

The effect of low-intensity laser therapy (LILT) on cutaneous wound healing and pain relief in rats

[Purpose] This study examined the impact of low-intensity laser therapy on wound healing and pain control using a rat cutaneous wound model. [Subjects and Methods] Twenty-four adult male Sprague-Dawley rats (between 220−240 g, 7 weeks) were used in this study. The rats were anesthetized and a circular fragment of skin was removed from the dorsal region of the back by a punch with an 8-mm diameter. The animals were randomly divided into 6 groups, Groups C 1, C 3, and C 5, control groups, received no laser treatment. Groups T 1, T 3, and T 5 received laser treatment for 20 min per day for 1, 3 and 5 days, respectively. Lumbar spine and dorsal skin were extracted and processed using western blot analysis. [Results] Periodical observation showed increases in NGF expression on the skin, and decreases in c-fos expression by the spinal cord in the treatment groups compared to the control group. [Conclusion] The present findings suggest that low-intensity laser therapy could be used as an effective therapy for wound healing and pain relief, and could be further used as a clinical approach for treating cutaneous wounds.Key words: Low-intensity laser therapy, Wound healing, Pain relief     

Effects of phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer related lymph edema

[Purpose] Breast cancer-related upper extremity lymph edema is known to cause physical, functional and psychological impairments in women after modified radical mastectomy. The aim of this study was to investigate the effects of phase I Complex Decongestive Physiotherapy (CDP) on physical functions and depression levels in women with breast cancer-related upper extremity lymph edema. [Subjects and Methods] Fifty-eight subjects with breast cancer-related upper extremity lymph edema were the subjects of this study. The arm circumference, shoulder range of motion (ROM), muscle strength and depression levels of the subjects were assessed before and after phase I CDP treatment. [Results] After phase I CDP, there was a statistically significant reduction in circumference measurements at all levels of the affected arm. There was not any statistically significant difference in muscle strength after CDP. The shoulder ROM improved after treatment. There was a significant reduction in the Beck Depression Inventory score. A significant positive correlation was found between depression levels and circumference measurement. [Conclusion] Based on the results we suggest that by reducing limb volume, beside improving physical functions, phase I CDP can affect psychological status, especially depression which is very common in women with breast cancer-related upper extremity lymph edema.Key words: Lymph edema, Complex decongestive physiotherapy, Depression     

Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature

The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment tools. [Subjects and Methods] Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: “temporomandibular joint laser therapy” and “TMJ laser treatment”. [Results] Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. [Conclusion] Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD.Key words: Temporomandibular joint disorder, Electromyography, Laser     

Changes in Pressure Pain Threshold of the Upper Trapezius,Levator Scapular and Rhomboid Muscles during Continuous Computer Work

[Purpose] This study investigated the changes in pressure pain threshold of the upper trapezius, levator scapular, and rhomboid muscles during continuous computer work. [Subjects] Fourteen males and females aged 26–32 years, were recruited. [Methods] A dolorimeter pressure algometer was used to measure the pressure pain threshold of the upper trapezius, levator scapular, and rhomboid muscles, respectively, before computer work and after 15 min, 30 min, and 60 min of computer work. [Results] The pressure pain threshold of the upper trapezius was significantly decreased after 15 min or more of computer work. The pressure pain threshold of the levator scapular was significantly decreased after computer work for 30 min and 60 min. The pressure pain threshold of the rhomboid muscle was significantly decreased after 60 min of computer work. [Conclusion] Continuous computer work could produce much more pain in the levator scapular and rhomboid muscle than the upper trapezius.Key words: Computer worker, Pressure pain threshold, Rhomboid muscle     

Analysis of the numbers of clinical trials on physical therapy in Japan: comparison with those in the North American register from 2010 to 2019

[Purpose] Information about clinical trials related to physical therapy (CTPT) in Japan, which has the highest aging rate in the world, is essential for physical therapy education, research, and policymaking to change and strengthen the education system and promote research grants. This survey aimed to clarify the proportion of CTPT in the clinical registry and compare the proportion of CTPT in Japan with that in North America. [Participants and Methods] The ClinicalTrials.gov (CTG) and National Institute of Public Health (NIPH) Clinical Trials were used. The number and proportion of CTPT were compared each year. The analyzed data spanned 10 years from 2010 to 2019. [Results] A total of 222,821 trials were registered in CTG during the 10 years. In search of “physical therapy”, 3,001 trials searched. The proportion of CTPT increased from 0.8% to 1.7%. In total 42,194 trials were registered in the NIPH Clinical Trials Search. From the CTPT, 141 trials were obtained. The proportion of CTPT increased from 0.05% to 0.5%. The proportion of CTPT in the NIPH Clinical Trials Search was one-third or less than that in the CTG. The proportion of CTPT in CTG increased yearly, but the proportion of CTPT in NIPH Clinical Trials Search has not increased since 2016. [Conclusion] The proportion of CTPT is relatively low in Japan, compared with that in North America, and it showed no increasing trend. It is important to provide education and support for clinical trials in an aging country such as Japan.     

Retrogression of Nervous Fibers According to the Age of Patients with Diabetes Mellitus (DM)

[Purpose] This study was performed to discover the possible onset time of diabetic neuropathy by age of diabetic patients, and to provide the knowledge necessary for preventing or managing diabetic neuropathy. [Subjects] The subjects of this study were outpatients who visited D Hospital Department of Neurology with complaints of significant neuropathic symptoms including dullness, numbness and paraesthesia. [Methods] Stimulations of 5 Hz, 250 Hz and 2,000 Hz were generated with a Neurometer CPT (Neurotron Inc., Baltimore, MD, USA) and delivered selectively to C fibers, A-delta fibers and A-beta fibers. The intensity of the stimulations of 5 Hz, 250 Hz and 2,000 Hz was incrementally increased as much as 0.01 mA. [Result] The results of this experiment show that the period of retrogression of nervous fibers was different significantly according to the age of patients with diabetes mellitus. Especially, in the case of individuals in their 50''s, Aβ, Aδ, and C fibers in both the right and left lower limbs significantly changed within a period of 2 months. In the case of individuals in their 60''s, Aβ and C fibers of the right lower limb meaningfully changed 2 months after the onset of the disease, and Aβ, Aδ, and C fibers of the left lower limb also significantly changed within a period of 2 months. [Conclusion] We discovered that patients suffering from DM especially in their 50''s or 60''s should be thoroughly followed for their condition, right from the onset of DM, in order to prevent the retrogression of nervous fibers.Key words: Diabetes mellitus, Nervous fiber, Neuropathy     

Effects of orthosis on balance and gait in healthy adults

[Purpose] This study evaluated the effects of an oral orthosis that can change body alignment on the balance ability and gait of healthy adults. [Subjects and Methods] The subjects of this study were 21 University students. A gait analyzer was used to analyze the subjects’ balance ability and gait quality. Two walking speeds were used: 2 km/h, a comfortable speed, and 4 km/h, a slightly faster walking speed. [Results] The step length, and base of gait at 2 km/h differed significantly after the intervention. The total step time and step length increased significantly after the intervention. Furthermore, the total base of gait decreased significantly after the intervention. The step times of the left lower limb at 4 km/h differed significantly after the intervention. [Conclusion] The oral orthosis tested positively affects the balance ability and gait of healthy adults.Key words: Orthosis, Balance, Gait