Efficacy of low-energy extracorporeal shockwave therapy and a supervised clinical exercise protocol for the treatment of chronic lateral epicondylitis: A randomised controlled study

This randomised controlled trial was designed to evaluate the efficacy of low-energy extracorporeal shockwave therapy with a supervised exercise protocol for the treatment of chronic lateral epicondylitis. Thirty patients of lateral epicondylitis were randomly placed into two groups: an experimental group (n = 15) and a control group (n = 15). The experimental group received low-energy extracorporeal shockwave therapy and supervised exercise once a week for 3 weeks, whereas the control group received a supervised exercise protocol three times a week. Both the groups were instructed to carry out a home exercise programme twice daily for 4 weeks.Outcome parameters included in this study were pain intensity, pain-free grip strength, and the Disability of Arm, Shoulder, and Hand questionnaire. Data were collected at baseline and after the end of treatment (at 4th week). There was a decline in pain, and improvements in pain-free grip strength and limb function in both groups compared with the baseline values. At the end of the treatment period, the experimental group had greater reduction in pain intensity and better improvement in limb function (p < 0.01). It can be concluded that low-energy extracorporeal shockwave therapy, when combined with regular exercise, is an effective method for reducing pain and improving upper limb function in patients with chronic lateral epicondylitis.     

Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization

Objective: To observe changes in cystometric parameters in individuals with spinal cord injury (SCI) with neurogenic bladder practicing clean intermittent self-catheterization (CIC) and incidence of urinary tract infection (UTI) in such patients.

Design: Prospective, observational study.

Setting: Tertiary Urban Rehabilitation Hospital.

Participants: Persons with neurogenic bladder caused by traumatic SCI and practicing CIC.

Interventions: Clinical evaluation, complete urine analysis, urine culture and sensitivity, ultrasonography of the abdomen and urodynamic study were evaluated at baseline and at follow-up (6 months to 1 year).

Outcome Measures: Detrusor pattern, cystometric capacity, detrusor compliance, detrusor leak point pressure, residual urine, incidence of UTI.

Results: Thirty-one participants were included in the study. The baseline cystometric study showed that 15 had overactive detrusor and 16 had detrusor areflexia. The mean cystometric capacity decreased significantly between baseline and follow-up in both the groups but remained within the normal threshold limit, decline being more marked in the overactive detrusor group, who also had more marked decrease in compliance. Mean detrusor leak point pressure was below 40?cm H₂O in all participants in both groups at baseline and follow-up. Mean residual urine improved at follow-up in both groups. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive detrusor group. Escherichia coli was the causative agent in 45%.

Conclusion: The cystometric capacity and compliance decreased significantly though patients were doing regular CIC and managed on antimuscarinics for detrusor overactivity (DO). UTI is more common in individuals with SCI with DO and E. coli is the most common cause of UTI.     

Effectiveness of electromyographic biofeedback training on quadriceps muscle strength in osteoarthritis of knee

The objective of this randomised controlled trial was to evaluate the effectiveness of electromyographic biofeedback as an add-on therapy with isometric exercise on quadriceps strengthening in patients with osteoarthritis of knee. Thirty three, 10 men and 23 women, patients with osteoarthritis of knee participated in the study. Patients were randomly placed into two groups: a biofeedback group (n = 17) and a control group (n = 16). The biofeedback group received electromyographic biofeedback-guided isometric exercise programme for 5 days a week for 5 weeks, whereas the control group received an exercise programme only. On between-group comparisons, the maximum isometric quadriceps strength in biofeedback group, at the end of 5^th week was significantly greater than that of the control group (p < 0.004). The addition of electromyographic biofeedback to a 5-week isometric exercise program appeared to increase quadriceps muscle strength, compared to the exercise program alone for people with knee osteoarthritis. The finding, however, should be interpreted with caution due to limitations of the study design.     

Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.Key words: Locomotor training, Spinal cord injury, Paraplegia     

Effect of gender on strength gains after isometric exercise coupled with electromyographic biofeedback in knee osteoarthritis: A preliminary study

ObjectiveThe objective of this trial was to evaluate the effect of gender on strength gains after five week training programme that consisted of isometric exercise coupled with electromyographic biofeedback to the quadriceps muscle.Materials and methodsForty-three (20 men and 23 women) patients with knee osteoarthritis (OA), were placed into two groups based on their gender. Both groups performed isometric exercise coupled with electromyographic biofeedback for five days a week for five weeks.ResultsBoth groups reported gains in muscle strength after five week training. However, the difference was found to be statistically insignificant between the two groups (P = 0.224).ConclusionThe results suggest that gender did not affect gains in muscle strength by isometric exercise coupled with electromyographic biofeedback in patients with knee OA.     

Comparison of energy cost in transtibial amputees using "prosthesis" and "crutches without prosthesis" for walking activities

BackgroundIn a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities.ObjectivesThe purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking.MethodsThirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b² oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO₂ rate (mL/min), VO₂ cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min).ResultsIt was observed that VO₂ uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (P < 0.025). There was significant difference between prosthesis walking and crutches without prosthesis walking in terms of VO₂ uptake rate (P < 0.005) and EE/min (P < 0.00001). It was noticed the adults with transtibial amputation using prosthesis walked with 21% more efficient in terms of VO₂ uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis.ConclusionsThe data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.     

Wandering spleen torsion in a patient with polysplenia syndrome

Polysplenia Syndrome is a rare condition that refers to the presence of 2 or more spleens in association with other thoracoabdominal abnormalities. Here, we report a case of a 13-year-old girl who presented with acute lower abdominal pain and was diagnosed with polysplenia syndrome after obtaining a CT scan of her chest, abdomen and pelvis. Diagnostic imaging also revealed the presence of a wandering spleen hanging in the lower abdomen and upper pelvic cavity and showing signs of infarction. The patient underwent splenectomy afterward and splenic torsion was confirmed intraoperatively. To the best of our knowledge, this was the first reported case of wandering spleen torsion in a patient with polysplenia syndrome. Physicians should keep in mind the possibility of a wandering spleen torsion presenting in various locations when dealing with polysplenia syndrome patients complaining of abdominal pain.