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Sacralization is an embryo congenital defect in which the fifth lumbar vertebra is fused to the sacrum in various degrees. The prevalence of sacralization is 7.5 percent. Sacralization can be unilateral or bilateral. This disorder arises due to irregularities in the lumbosacral spine segmentation during development. Transverse process of the L5 on one side or both sides is wider than usual and fuses into the sacrum or ilium or both in the sacralization of the fifth lumbar vertebra. Low back pain is the most common symptom in most of the population throughout their lifetime. As low back pain is a leading cause of disability, interfering with quality of life and job outcomes our goal is to assess the association between sacralisation and low back pain. Purpose: To study the relationship between sacralization and low back pain. Because the role of sacralization throughout causing LBP is still controversial. This is the observational study which includes 55 participants who have low back ache. The participants are between the ages 60 to 70 years. The intensity of pain was assessed through NPRS. To assess the relationship between Sacralization and low back pain, all the participants were sent for Xray and the presence of Sacralization was assessed by X-ray. We found that there was a significant relationship between sacralization and low back pain. The patients with sacralization show the high intensity of low back pain. We concluded that Sacralization affects the lumbosacral spine in different ways and result in pain in lower back. And there is significant association of sacralization with low back ache.

Now a day’s abnormal uterine bleeding in premenopausal women is the most common indication of hysterectomy which usually results from myomas and adenomyosis. In this case study, a 38-year-old female, with a complaint of abnormally heavy bleeding with menstrual cycle irregularity and discomfort for 15 days each month with dysmenorrhoea. She was diagnosed for large fibroid deposition at the posterior wall of the uterus and extroverted in the position. So, she was prescribed for vaginal Hysterectomy by a gynecologist further investigation, she underwent a vaginal hysterectomy, post-operatively patient was complaining about lower abdominal pain and difficulty in bed mobility activities. There was weakness in pelvic floor muscles after the surgery, due to which she had worried about overweight, physical health, and her quality of life. So she approached the physiotherapist, where she had trained for pelvic floor muscle training two-three sessions per day for two weeks with abdominal, back, and hip strengthening exercises with a home exercise program. VAS scale, Oxford grading system, PFIQ, QOL questionnaire was taken as outcome measure prior and after the intervention. The present case report emphasizes the effect of the combination of different exercises for pelvic floor muscles encasing the comprehensive rehabilitation plan including a home exercise regimen allowing the patient to recover early and return to daily activities.

PIVD is the protrusion from the nucleus pulposus through the rent within the annulus fibrosis. L4-L5, L5-S1 discs are most commonly affected in 95 percent of lumbar disc herniation. As we grow older the discs which are present in our vertebral column, become less flexible and begin to harden, making it more susceptible to tears. The herniated disc may be caused by a single undue strain or injury. However, as disc degeneration progresses with age, a few people may suffer herniated discs from more minor activities or twists. The patient was a 38-year-old female who presented with a complaint of pain in the neck & back which was 8 on Vas, pain in both limbs ( upper & lower) which was 7 on Vas, Numbness present in Upper limb fingers, Stiffness in all joints along with pedal edema. The patient also had a varicose vein on both lower limbs grade 3. She was admitted to the hospital because she was not able to even get up from the bed due to pain. She was working in a mess for 8 years the work included prolonged standing, bending down, lifting heavy weights, and sitting on the floor for a long period. Due to pain, she was not able to continue her work. Ayurvedic treatment along with physiotherapy treatment was going on. The patient had the same complaints before 12 months she was relieved by physiotherapy. The patient had three laser sessions done for a varicose vein but was not relieved before 1 year. According to the clinical presentation and Radiological findings the patient was diagnosed with PIVD. This case study shows that regular exercise, traction, back strengthening exercise, use of modalities such as IFT, and following proper ergonomics would reduce the symptoms associated with PIVD and varicose veins

Selective neck dissection (SND) is a surgical procedure developed to remove cervical lymph nodes at the risk of invasion metastasis. It is distinguished from radical neck dissections wherein there is the retention of one or more groups of lymph nodes. In this case, a 45-year-old male shopkeeper diagnosed with malignancy of lower anterior alveolus from 45-36 region (stage IVA –T4a N2Cm0) underwent SND, segmental mandibulectomy, and reconstruction with pectoralis major myocutaneous flap (PMMC flap) on the left side. On assessment, before the SND, Scapular mal positioning, inferior medial border prominence, coracoid pain, and dyskinesia of scapular movement (SICK) were identified. The patient was referred for physiotherapy with the complaint of inability to maintain saturation, difficulty in decannulation, and shoulder dysfunction on postoperative day 3 (POD-3). Chest physiotherapy comprising of breathing and suctioning techniques aided early decannulation. Furthermore, a prompt shoulder rehabilitation program for six months had a positive impact on the overall functioning and quality of life of the patient.

Hematometra is a rare condition that involves blood accumulation or retention in the uterus; caused by a structural obstruction of the cervical canal, which may be congenital or acquired. Amenorrhea or dysmenorrhoea in premenopausal women, pelvic pain, and urinary incontinence are common symptoms associated with this condition. In this study, a 39-year-old woman presented with a hematometra complaint associated with lower abdominal pain and urinary incontinence. After more USG and MRI studies, she underwent subtotal hysterectomy and hematometra draining, but after surgery, she started to feel pain in her left lower abdomen and urinary incontinence. The patient attended 12 days of therapy over the course of two weeks. Physical therapy including Kegel’s exercises, breathing exercises, and instruction in relaxation techniques, postural advice, gait training, and a home program to training for the activity of daily living activities. The patient reported reductions in symptoms in the Pelvic Floor Impact Questionnaire (PFIQ-7) at the time of her physical therapy discharge, and was able to resume activities that she had not previously tolerated due to abdominal pain and urinary incontinence.

Acute Respiratory failure often refers to the inability of the body system to maintain optimum arterial and tissue oxygen levels or to optimally expel out carbon dioxide. It is, therefore, hypoxemic or hypercapnia in nature or both depending on the root pathogenesis. A 72-year-old female patient was admitted to the hospital with complaints of breathlessness at rest with NYHA grade 4, dry cough (nonproductive), and orthopnea. The patient is a known case of Diabetes Mellitus type 2 for the last 5 years. On the day of examination patients were breathless using accessory muscles for respiration. The patient was tachypnea. The chest expansion, as well as excursion, was significantly reduced. On auscultations in Coarse crackles were heard. X-ray showed pneumonitis changes. ABG showed respiratory acidosis without compensation initially. Physiotherapy intervention included patients and their family members counseling, airway clearance techniques, energy conservation methods, and adaptation to complex positions with the maintenance of Spo2. Outcome measures have shown enhancement in functional independence and bedside daily activities. Pulmonary Rehab with efficient family counseling is effective in the overall improvement of the patient’s condition with acute respiratory failure.

Pulmonary tuberculosis is a contagious disease of the lung caused by mycobacterium tuberculosis. The disease is curable and preventable, but its sequelae induce structural lung damage, physiological dysfunction resulting in disability, respiratory distress, and decreased exercise capacity affecting ADLs. Pneumothorax is considered to be a major complication of TB among all the known sequelae. In the present case, the patient complained of moderate dyspnea, chest pressure, and chest pain. Based on chest radiography and a previous diagnosis of pulmonary tuberculosis, the patient was diagnosed with secondary spontaneous pneumothorax (SSP). The pneumothorax was relieved by medical intervention, i.e. by intercostal drainage, but our goal was to increase the ventilation and oxygenation of the lungs, improve airways hygiene, improve the exercise tolerance and minimize the work of breathing so that the patient can go back to his normal day-to-day activities without any trouble. A comprehensive pulmonary rehabilitation plan was structured to suit the patient's goal and was implemented and routinely followed for 1 month. It included a range of interventions like breathing exercises, airway clearance techniques, physical mobility exercises, and posture retraining. The patient demonstrated significant functional improvement in aerobic capacity, endurance, exercise tolerance capacity, and increased shoulder joint mobility. In the present case, it has also been validated that medical management anchored with Pulmonary Rehabilitation will help in gaining better outcomes.

The International Continence Society (ICS) describes incontinence as an objectively demonstrable loss of urine which is not voluntary and that is a social and/or sanitary issue. The complaint of leakage of urine, which is not voluntary on an effort made, on exertion, on sneezing or while coughing is described as Stress urinary incontinence (SUI). The intra-abdominal increases as the effort or exertion increases, and the urethral sphincter is not capable to sustain a pressure greater than the pressure applied on the urinary bladder. Eventually, leakage of urine occurs during the daily activities like lifting, laughing, jumping, while sneezing or coughing. In women, stress urinary incontinence is most common category of incontinence of urine. Even though it isn’t a lethal illness. SUI has a number of negative effects on women's quality of life, including restricting social interaction and relationship and the personal relationships but also physical activity. Cystocele is the weakness of pubocervical fascia, which makes the urinary bladder to descend downwards and backwards against the anterior wall of the vagina. If this is a not taut then it will protrude. In more extreme cases a pouch of bladder sets up which holds on to the residual urine. The conservative treatment, a nonsurgical therapy, includes ameliorating the living standards, urinary bladder training, pelvic floor muscle exercises and strengthening. Kegel exercises are the most effective form of strengthening muscles of pelvic floor in addition are a noninvasive therapy and the use of vaginal weights or cones are not included. The rehabilitation and strengthening muscles of pelvic floor is facilitated and promote urine storage. The combination of Kegel’s exercise along with other interventions for a span of six weeks has shown a significant improvement in the symptoms.

Low backache is the most common health condition among adults which leads to pain and disability. Radiculopathy is a impaired condition that causes low back pain that radiates to the lower extremity. The aim of this case study is to establish a comprehensive physical therapy plan for a patient who has chronic low back pain and PIVD. The patient was a 30-year-old female with a one month history of LBP. The pain further radiated to both legs. Further magnetic resonance imaging (MRI) was done, which indicated PIVD at the level ofL4-L5The patient's main concern about her condition was that she was unable to work, engage in her once-loved hobbies, and function without pain or discomfort, and pain has disrupted her sleep. After eight weeks the pain level on the Numerical Pain Rating Scale had reduced from 7/10 at worst to 2/10. The patient said that aggravating pain is reduced. Capacity to function has been restored and sleeping has also been improved. A detailed physical therapy program that included a patient with chronic low back pain and PIVD are McKenzie extension exercise, therapeutic exercise, electrical stimulation, individualized patient education, manual techniques, superficial heat and home exercise program.

An acute inflammation associated with lung tissues, alveoli and neighbouring airways caused by streptococcus pneumoniae is referred to as pneumonia. One of the most commonly affecting health problem at all age groups in the world is pneumonia. Antibiotics are the main treatment plan for management of pneumonia, while other treatments are mainly used as supportive care. The purpose of this case report is to evaluate the effect of physiotherapy as an adjuvant for pneumonia management. The patient was a 50 year old male with complaints of dry cough, high grade fever which was associated with chills and breathlessness. He was then diagnosed with pneumonia. Medical management with antibiotics was started along with physiotherapy as an adjuvant. The aim of physiotherapy was to return the patient to his best possible functional recovery. After completion of physiotherapy the patient gained maximum re-expansion of the thorax, had no breathing difficulties, the lungs were clear of sputum and patient was functionally independent. This case report shows how physiotherapy can be used as an adjuvant to rehabilitate a patient diagnosed with pneumonia. This has been demonstrated by increasing the lung expansion, airway clearance and gaining functional independence

In pes anserine bursitis patient complaint of medial side knee pain which is in inflammatory condition. The case report aims is to present evaluation & treatment of young female who’s working in the medical field which majorly involved long-standing. In addition to traditional methods of treatment, we focused on her muscle strength & biomechanical correction to improve her ADLs. A 27-year patient came to OPD with severe pain, swelling, tenderness which affected her daily functional activity. In pes anserine bursitis improvement of whole biomechanics is very important. To improve the biomechanics of the hip, knee, ankle, core we started planning 9 days strengthening program. Initial 3 days, the patient had severe pain & swelling over the inner side of the knee. We explain the effect of exercise to the patient & asked her to avoid the brace. Initially, due to this problem list, we gave her simple exercise with that cryotherapy & electrical modality to reduce the symptoms. In the next 7 days, we focused on improving the all-affected muscle strength, in this patient we had to correct the overall biomechanics to improve quality of life. We focused on strengthening core muscles, back muscles & all the weak muscles. Initially, we started with Thera Band, then with weight cuff & progress with Bosu ball training for balance & proprioception section. In addition to traditional method the strengthening exercises & biomechanical correction of lower limb showed early recovery.

Distal end radius fracture is said to the most common as well as more frequent fracture seen in community-dwelling individuals. Fracture distal end radius can lead to malunion, non-union, deformity ultimately leading to reduce the functional capacity of an individual. Hand functions are primarily affected in distal radial fracture. The patient was an old lady of 75 years who suffered a comminuted fracture distal end radius right side. She underwent surgery 6 days after the injury with open reduction and internal fixation. Three weeks after the surgery physiotherapy was started to increase range of motion, muscle strength and to reduce pain. Rehabilitation started at the rate of one session a day, six days a week. Rehabilitation activities include exercises to improve local circulation and relief pain, to restore normal range of motion, to improve ROM, to improve strength.

Novel coronavirus (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause severe pneumonia and acute respiratory distress syndrome which causes breathing difficulty requiring ICU management and assisted ventilation. A male patient, 50 years old was admitted to the hospital with complaints of breathlessness, morning chest pain with palpitations and low saturation level, and hypoxia on room air. The patient was a known case of COVID-19. ABG revealed metabolic alkalosis with partially compensated respiratory acidosis. CBC revealed leukocytosis suggestive of infection and HB count was decreased. HRCT thorax was done given COVID positive PCR test and was suggestive of multiple patchy ground-glass attenuations in the left upper and bilateral lower lobes of lungs. A repeat HRCT thorax was done after 3 months, which was suggestive of diffuse patchy ground-glass opacities with interlobar septal segment giving crazy paving pattern and consolidation in both lungs. Physiotherapy intervention included patient education, breathing retraining, airway clearance techniques, positioning, walking program with supplemented oxygen, and psychological support. Outcome measures have shown enhancement in functional independence and performance of activities of daily living. Modified pulmonary rehabilitation has worked efficiently in improving the general condition of a post COVID patient. © 2021 MEDIC SCIENTIFIC. All right reserved.

Varicose veins are permanently dilated tortuous and elongated path causing abnormal circulation. The varicose vein is the most common condition among females. The prevalence of varicose veins shows that females are more affected by it. In India, it is most common in females due to long-standing household work. Varicose veins are classified according to the long great saphenous vein varicosity, short/small saphenous vein varicosity, and varicose veins due to perforator incompetence. The calcaneal spur is also known as a heel spur and it occurs due to a bony outgrowth that is present in the heel bone. The heel spur is located at the back of the heel or under the sole. The spur occurring in the back of the heel is often associated with Achilles tendinopathy and the spur under the sole is associated with plantar fasciitis. A 55-year-old female with right-hand dominance came with complaints of pain in both the lower limb, pain in the neck region, and heel pain with these complaints patient was referred for physiotherapy after Ayurveda treatment. The patient presented with a history of osteoarthritis 5 years back, following which she started having pain in both the lower limb and heel. Patient were diagnosed with varicose vein and calcaneal spur with cervical radiculopathy. Therapeutic intervention for the patient comprised of patient education, thermotherapy, ultrasound, TENS, strengthening exercises, and range of motion exercises. The outcome of all this intervention showed improvement in function. Early physiotherapy intervention after diagnosis should be started to improve quality of life, activities of daily living, and prevent chronic disability.

The emergence in China of 2019 of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) previously provisionally names 2019-nCoV disease (COVID19) caused major global outbreak and is a major public health problem. On 30 January 2020, the WHO declared COVID19 to be the sixth international public health emergency. This present pandemic has engrossed the globe with a high rate of mortality. As a front line practitioner, physiotherapists are expected to be getting in direct contact with patients infected with the virus. That’s why it is necessary for understanding the many aspects of their role in the identification, contains, reduces and treats the symptoms of this disease. The main presentation is the involvement of respiratory system with symptoms like fever, cough, sore throat, sneezing and characteristics of pneumonia leads to ARDS(Acute respiratory distress syndrome) also land up in multiorgan dysfunction syndrome. This text describes and suggests physiotherapy management of acute COVID-19 patients. It also includes recommendations and guidelines for physiotherapy planning and management. It also covers the guidelines regarding personal care and equipment used for treatment which can be used in the treatment of acute adult patients with suspected or confirmed COVID-19.

Due to the rapid spread of COVID-19, some of the major preventive measures such as complete lockdown of the country with the availability of only essential services that lead to a lot of changes in people’s daily lifestyle and work pattern The mobile device has had a significant impact on everyday life in all ages and in almost of the countries The average time reported spent on internet use was 2 13 hours every day in the Indian population Mobile device users complain of discomfort in at least one area of the upper extremities, upper back, or neck pain, shoulder pain, wrist and hand pain, and finger discom-fort Long-term use of smartphones causes continuous mechanical stress on the tendons, muscles, and perimetric tissue, which can induce various muscu-loskeletal symptoms The use of smartphones in a sitting position may lead to more shift in head-neck angle than in a standing position The main aim of this article is to understand the overview of musculoskeletal check during this time of lockdown, where we all have to experience changes in our lifestyle pattern by staying indoors So the overview of this article is concluded by giving a scientific understanding behind keeping a musculoskeletal check in smart-phone overuse in lockdown phase, which is of great importance to optimize, maintain & improve the overall performance of the body © International Journal of Research in Pharmaceutical Sciences

Fear is an uncomfortable feeling, which results from the proximity of actual threat or pain. A strong correlation exists between fear and pain. Kinesiophobia is the phobia of activity and physical movement, which results from a sensation of sensitivity to painful injury or reinjury. Low back pain (LBP) is among the frequent disorders of the musculoskeletal system. LBP is mainly due to bad postures and poor organisational ergonomics. Kinesiophobia has adverse effects on rehabilitation outcomes. So the systematic application of graded exposure to movements is recommended in patients with Kinesiophobia to prevent pain-related anxiety. We compared Kinesiophobia's impact on patients with both acute and chronic LBP. We aimed to find out the role of Kinesiophobia in patients having LBP. The survey-based research using Tampa scale of Kinesiophobia was conducted with cross-sectional design. It included participants of both genders,in the age group of 18-65 who were diagnosed with acute and chronic low back pain. Tampa Scale for Kinesiophobia, Evaluation Performa, NPRS and Goniometer were used as outcome measures for the study. The patients were thoroughly examined, and they were evaluated using the Tampa Scale. Scoring to 17-items Tampa Scale was performedin4-point Likert scale varying from “strongly disagree” to “strongly agree.” After the inversion of items 4, 8, 12, 16, the final score was determined. The total score ranges from a minimum of 17 to a maximum of 68. It was concluded that Kinesiophobia plays a crucial role in LBP, especially chronic LBP.

Goyal-Naqvi syndrome (GNS) is a newly documented clinical entity that comprises trisomy 10p and terminal 14q deletion, though trisomy 10p and terminal 14q deletion have been discovered as distinct conditions in 1974 and 1997, respectively. Nevertheless, to date, the total number of reported cases of each of these conditions is estimated to be in double digits. Both manifest as a constellation of features like craniofacial dysmorphism, hypotonia, intellectual impairment and global developmental delay. Characteristic facies include protruded forehead, hypertelorism, epicanthic folds, down slanting palpebral fissures, flat nasal bridge, long philtrum, thin upper lip, carp-shaped mouth, retro-micrognathia and low set ears. Besides, trisomy 10p is strikingly associated with clinodactyly and camptodactyly which aids in clinical diagnosis, apart from other musculoskeletal deformities like hip dysplasia and pes planus. Intersex conditions have been found to commonly co-exist. As other systems also display involvement frequently, trisomy 10p is a discernible multiple congenital anomalies/mental retardation (MCA/MR) syndrome. On the other hand, with terminal 14q deletion, increased risk of certain types of cancer was predicted as specific tumor suppressor genes are lost in the deletion and thus, screening was recommended. Genetic workup using techniques like fluorescence in situ hybridization (FISH), spectral karyotyping (SKY) and chromosomal microarray-based comparative genomic hybridization (CGH) was found to be helpful in diagnosis of trisomy 10p and 14q deletion. Prenatal diagnosis of these conditions has been well documented too. Intrauterine growth retardation has been observed to be related to trisomy 10p. There is a paucity of literature on the management of children diagnosed with trisomy 10p or with terminal 14q deletion. Although management of a child diagnosed with concomitant occurrence of trisomy 10p and terminal 14q deletion by a multidisciplinary approach emphasizing physiotherapeutic intervention has shown remarkable improvement in motor skills, the care of children diagnosed with these genetic aberrations needs further investigation. Documentation of more such cases will help to expand phenotypic spectrum for early identification and to delineate natural history for a life span approach. Early identification and intervention facilitate tapping of the maximum neuroplastic potential for better neurodevelopmental outcomes. We present a review of current literature on this novel syndrome to identify gaps in knowledge to build future research.

Premature birth is the most common cause for a stay in the neonatal intensive care unit (NICU) among neonates. Premature birth leads to prematurity, which is associated with complications such as respiratory distress syndrome (RDS), hyperbilirubinemia, gastroesophageal reflux (GERD), intraventricular hemorrhage (periventricular leukomalacia), retinopathy of prematurity (ROP), and so on. These secondary complications are of great concern and need to be handled with care to prevent the further deterioration of the quality of life of the baby as he grows. So, the early physiotherapeutic interventional approach comes into light and plays an important role in neonatal care.This case study demonstrates an infant boy of seven months chronological age, who had a preterm birth history with a poor APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score and NICU stay during the first three months of life. He approached the physiotherapy outpatient department with a complaint of delayed motor milestones like an absence of head holding, rolling, opening of hand, as well as delayed social-emotional development, Ryles tube (RT) in situ, with frequent episodes of GERD, neck rotated to the left side, high irritability, tactile defensiveness of both hands, and difficulty in regulating his sensory systems. Outcome measures used were gross motor function measure (GMFM), sensory profile, and rotating chair test. Early interventional physiotherapy was given including neurodevelopmental techniques (NDT), oromotor stimulation, sensory integration, passive stretching, and myofascial release for six days per week with each session of 45 minutes. The results demonstrated the achievement of motor milestones till sitting independently, reduced episodes of GERD, discontinued RT in situ, improved mobility of neck on both sides, reduced irritability, and started reaching, grasping along with bimanual tasks.

Introduction: Anxiety disorders impact a large number of population all over the world, prohibiting them from undertaking everyday tasks such as driving, staying in crowded places, or dealing with strangers. The Hamilton anxiety (HAM-A) scale is the first rating Questionnaire for determining the sign anxiety symptoms. HAM-A is a 14 point scale containing a clinician-based questionnaire that has been utilized as a self-scored survey based on both physical and psychological symptoms. The components of questionnaires for analyzing the depressive or anxious symptoms are developed and tested in medical practice with great success. Virtual Reality (VR) is a computer-simulated world that allows the user to feel as they are physically present in it. Oculus rift is a VR ski-masked shaped goggle having a better and deeper understanding of the range and user experiences that will help to guide future efforts.Method: The cross-sectional observational study will be including 70 participants aged 18 to 32 from Ravi Nair College of Physiotherapy, India for the study. With intervention, the duration of analysis of the study will be of 6 months. HAM-A scale is used to evaluate the symptoms of anxiety in people before they show up on the oculus rift.Discussion: The study will evaluate the severity of anxiety before going to VR surrounding. Virtual reality devices are more popular, many studies have been undertaken on the construction and validation of interfaces, but more research is needed on anxiety before entering a virtual reality environment has been limited; specifically, There are only a few techniques that may be used to measure anxiety in a virtual reality surrounding.The Institutional Ethical Clearance reference number for this study is RNPC/IEC/2020-21/0012.

Trisomy 10p is a rare entity to be diagnosed and so is terminal 14q deletion. The total number of trisomy 10p cases reported to date is estimated to be in double digits. The number of terminal 14q deletion cases that have been reported in the literature is even lesser than that of trisomy 10p. Simultaneous occurrence of these genetic aberrations is, therefore, extremely rare. Herein, we document a case of a 14-month-old female diagnosed with trisomy 10p and terminal 14q deletion, who presented with an inability to sit without support and had difficulty in holding her neck. She had no means of independent indoor mobility, which was further limiting her development by exploration. Clinical features included hypotonia, developmental delay, extraneous movements of the head and tongue, intellectual impairment, and facial dysmorphism. She could maintain tripod sitting for less than a minute. Physiotherapy intervention was based on principles of neurodevelopmental treatment and sensory integration. After nine months of physiotherapy intervention, her total gross motor function measure (GMFM) score improved from 11% to 40%. The functional gains were maintained with a home exercise program, after almost one year of discontinuation of institution-based physiotherapy. To the best of our knowledge, this is the first report on the management of a child with the diagnosis of trisomy 10p along with terminal 14q deletion. Further research on the role of early intervention to maximize functional potential in rare genetic conditions is warranted.

The study aimed to determine the interactive effects of smartphone use on hand grip strength as well as functional hand performance in young people. The evolution of technology smartphone has become our necessity. It has made our lifestyle more comfortable in the form of browsing the internet, important conversation, and source of entertainment. However, it has negatively impacted our lifestyle too. Smartphone consumption among the young population has become broadly popular for different purposes aside from communication including playing games as well as internet browsing. The main complications associated with the increase in the use of smartphones results in weakness of the hand as well as wrist. High levels of smartphone use diminished hand grip strengths as well as and hand function leading to decreased hand grip strength in their dominant hand.

Background Post-operative delirium (POD) is associated with higher rates of functional decline and death. Ondansetron is a serotonin antagonist which could represent a therapeutic or preventive option in POD. Methods A systematic review of MEDLINE, EMBASE, CENTRAL, and PsychINFO was performed. Three randomized controlled trials (RCTs) met inclusion criteria (intervention of ondanse-tron compared to a control group). Results Two RCTs examined ondansetron for the treatment of POD in patients after cardiac or post-trauma surgery in the ICU. Studies assessed either a one-time dose or doses for 3 days of ondansetron or haloperidol IV. They suggested similar reductions in average delirium scores and rates in both in-terventions, although one study suggested ondansetron to be associated with higher rates of rescue haloperidol use. One RCT examined prophylactic ondansetron versus placebo IV, for five days postoperatively, to prevent POD in orthopedic patients. There were significantly fewer delirious patients in the ondansetron group. In general, studies had major meth-odological limitations and were very heterogenous in study tools, interventions used, and populations studied. Conclusions Ondansetron may be an effective agent for the prevention or treatment of POD, but studies are few and of poor quality, thus making the conclusions tenuous. Further large RCTs are needed.

Introduction: - Increase in body mass index suggests an increase in adiposity, Excess body fat depositionleads to change in the Center of Pressure which leads to altered biomechanics of the body. Different systemswork together to maintain balance. The present study finds a relationship between BMI and dynamic balancein young adults with flexible flat foot.Method: - In this study, 30 participants were recruited based on inclusion and exclusion criteria. Of the30 participants; 10 were of normal weight, 10 were overweight and 10 were obese. Y balance test wasperformed.Discussion: - The study showed that dynamic balance significantly changes with an increase in weight inyoung adults with flat feet. It is more significant in overweight and obese subjects. Any changes in ankleand foot complex leads to changes in weight-bearing, muscle imbalance static as well as dynamic balancein ambulation.

Introduction and Objectives Comorbidities in idiopathic pulmonary fibrosis (IPF) can impact patient quality of life and reduce survival (Kreuter et al. Respiratory Research 2007; 18:139). This study aims to review the routine use of screening questionnaires to aid identification of anxiety, depression, obstructive sleep apnoea (OSA) and assess related quality of life in patients with IPF. We hypothesise that a significant number of patients with previously unmanaged anxiety, depression and OSA will be identified and will report a reduced quality of life. Methods An electronic tablet with screening questionnaires, including Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), STOP-BANG Sleep Apnoea and King’s Brief ILD Questionnaire (KBILD), was provided to each patient with IPF to complete before review with the specialist pharmacist. Patients identified at risk of these comorbidities were referred for further investigation and/or management. Results A total of 55 patients with IPF completed the screening questionnaires. Of these, 29% (n=16) were identified with some depressive symptoms (16%, n=9) or probable major depression (13%, n=7), 16% (n=9) were identified with mild anxiety (5%, n=3) or significant anxiety (10%, n=6) and 58% (n=32) were identified at high risk of sleep apnoea and referred for further investigations. All of these patients reported a reduced quality of life. Conclusions Screening questionnaires can be useful for the identification of comorbidities such as anxiety, depression and sleep apnoea in IPF. We suggest ongoing studies to assess how quality of life is affected by these comorbidities and to review impact of intervention over time.

Background and objectives- Low back pain (LBP) is the key contributor to ages of disability. Although Lowback pain puts an immerse economic strain on healthcare services, this disease is responsible for impactingpeople’s daily lives. Low back pain is a widely common illness impacting persons of all ages. Sleep is anintricate and fundamental organic element with the social objective of keeping up homeostasis by methodsfor various physiological frameworks. Sleep quality has gained interest for people with musculoskeletalpain conditions as a contributing factor to the outcome. Sleep consistency has created consideration as a riskfactor to the outcomes for people with MSK pain disorders. Some studies show a bidirectional link betweenintensity of pain and sleep quality. Recent attention to the combination of inflammatory processes in pain onthe one side and sleep on the other, contributes to neuro-immunological mechanisms that may contribute tothe near connection between pain and sleep.Aim and objectives- To study association of poor sleep with low back pain among symptomatic andasymptomatic population.Materials and Method- All asymptomatic and symptomatic individuals with low back pain in the groupbetween 35-50 years of age will fill the survey using Visual Analogue Scale (VAS) and Insomnia SeverityIndex Questionnaire, and further data will be analyzed.Result- The parameters of outcome measures of both the group of low back pain individuals will be analysedusing the statistical test namely students paired T-test.Conclusion- Based on the previous studies we assume that there should be a positive association betweenboth poor sleep and low back pain.

Background: In upper cross syndrome (UCS), weaker neck flexors, anterior and middle serratus and lowertrapezius along with rhomboids usually develop, and tightness of the levator scapulae, pectoralis major andupper trapezius are biomechanically adapted. Active Release Technique (ART) helps to reduce discomfortand improve the range of movement. Also, Active Release Technique (ART) is a manual procedure which isalso being used for other soft tissue rehabilitation as well as for the management of the scar tissues. UCS andneck pain is common with uncomfortable job postures as well as in stress and anxiety, due to which muscledysfunction starts which can further followed by altered posture around the neck.Aim and Objective: To evaluate the effects of Active Release Technique verses conventional physiotherapyin management of upper cross syndrome physiotherapy.Materials and Method: 35 patients will be grouped in two groups. Both groups will be treated for sixsessions. Group A will be treated with active release technique and static stretching along with hydrocollatorpack. The patients coming under Group B, conventional physiotherapy would be given which include uppertrapezoid stretching, levator scapulae and pectoralis major as well as rhomboid strengthening, deep neckflexors, lower trapezius along with the hydrocollator pack.Result: The parameters of outcome measures in interval of pre and post treatment will be analysed using thestatistical test namely students paired T test.Conclusion: Based on the previous data of ART we assume it will be beneficial in relieving the symptomsinvolved in UCS.

Introduction: Postoperative contra lateral morbidity following fracture fixation surgery is rare due tohemilithotomy placement on traction table. Following a typical orthopedic femoral nailing, we should notea case of unexplained typical peroneal nerve palsy formed on the contra lateral side, manifesting with dropfoot.Case report: After prolonged femoral nailing, a 32-year-old male suffered an uncommon common peronealnerve palsy that manifested itself toward lateral drop foot. This iatrogenic and intermittent disorder wasdelineated to be position-related neuropraxia after neurophysiological analysis and review of applicableliterature.Conclusion: Place modification at intervals or complete avoidance of excessive hyperflexion of the knee isadvised to prevent typical peroneal nerve morbidity against the lateral.

Introduction: Increased number of high BMI individuals eventually leads them to low self-esteem, low selfevaluation which can lead to self-destructive behaviours such as uncontrollable dieting or overeating.thus,in order to evaluate the eating attitudes a study is conducted among the undergraduate students. Incidenceof fast food is increasing rapidly day by day especially in the young individuals, with improper food eatinghabits at irregular intervals which includes increased intake of carbonated soft drinks in young individuals,due to which there is increased risk of various health hazards out of which the most commonest healthhazard is increased risk of obesity in young population especially of urban region obesity also affects theindividuals in different aspects such as lethargy, psychological disturbances and physical inactivity leadingto increased risk of cardiovascular complications. EAT -26 questionnaire is a screening measure whichhelps in determining whether you might have an eating disorder that needs professional attention. Thisquestionnaire is a screening measure and is not designed to make a diagnosis of an eating disorder or toreplace the place of a professional consultation.Objective: The objective of the study was to get the number of individuals at risk and to analyse the changein the food habits.Study design: The design of the study is Observational with 1 month study duration.Result: 44 students were having inappropriate eating disorder whereas 156 students were having normaleating habits.Conclusion: 22% of students are at risk of eating disorder tested by EAT 26 questionnaire .

Xia-Gibbs syndrome (XGS) is a rare genetic disorder that has been discovered as a distinct clinical entity in the recent past. The occurrence has been attributed to the mutation of AT Hook DNA binding motif Containing 1 (AHDC1) gene that is carried on chromosome 1p36. The concerned gene participates in deoxyribonucleic acid (DNA) repair apart from other crucial functions. The mutation results in dysfunction that leads to neurodevelopmental delay. The spectrum of manifestations constitutes intellectual disabilities, hypotonia, expressive language delay, sleep difficulties, and short stature. Dysmorphic facial features include depressed nasal bridge, hypertelorism, down-slanting or up-slanting palpebral fissures, horizontal eyebrows, dysplastic dentition, thin upper lip vermilion, and micrognathia. The phenotype is still expanding. The condition may range from mild to severe dysfunction depending on the area and site of genetic aberration but variation is evident. Thus, the correlation between genotype and phenotype is largely unclear. XGS should be considered as a differential diagnosis for patients presenting with intellectual as well as developmental disabilities. Whole-exome sequencing (WES) is the genetic test that is largely used for the confirmation of diagnosis. Less is known about the natural history as only a few adults with XGS have been documented in the literature. Age-appropriate cancer screening is recommended for patients with XGS as the gene mutation alters DNA repair mechanisms that may trigger tumour formation. The management of patients diagnosed with XGS is an area that needs investigation. Though use of growth hormone replacement therapy and physiotherapy intervention have been reported as effective in previous studies, research on effective means of care of these patients is warranted on a larger number of patients. We present a review of current literature on what is known about XGS that would facilitate to identify knowledge gaps for paving a way for further studies. This, in turn, will help in provision of early and effective rehabilitation services for patients with XGS.

We report the case of a 5-month-old male, born out of a nonconsanguineous marriage, who presented with an inability to hold neck. As per the parents, he had diminished spontaneous movements since birth and described him as lethargic. He was clinically diagnosed with cretinism by a pediatric neurologist. He was referred by to the department of physiotherapy for evaluation and advice for the associated motor delay. On observation, the infant displayed peculiar clinical features of sparse hair, periorbital edema and macroglossia (A). Irritability, hoarse cry, abdominal distension and frog leg position was observed in supine lying position (B). Examination revealed generalized hypotonia, wide fontanelles, feeding difficulties and global developmental delay. He was neither able to roll over from supine to prone nor was he able to hold neck adequately. He had head lag during pull to sit test. Due to financial constraints, they were not willing to attend physiotherapy sessions on a regular basis. Thus, parents were educated about the home exercise program that included active assisted rolling, neck extensor muscles facilitation against gravity while lying prone on forearm, active assisted reaching out for objects while lying, neck flexor muscles facilitation in gravity minimized plane and active neck rotations to look at objects of interest while side lying on forearm support. Congenital hypothyroidism is still a common cause of developmental delay in newborns of the developing countries. Awareness, universal newborn screening, prompt recognition and medical treatment along with physiotherapy can minimize adverse effect on the physical and neurocognitive development.

Kinesiophobia is an irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. According to the concept of avoidance of fear, pain is interpreted as threatening, which can trigger pain-related fears and anxiety leading to avoidance behavior. Avoidance action involves a process/period characterized by a person stepping back from undertaking daily tasks like exercise, socializing, and work, which increases the intensity of the painful experience. In hospital settings, kinesiophobia needs to be resolved to ensure a positive result in rehabilitation interventions. The femur is the lower extremity's primary weight-bearing bone. Early fracture fixation in the shaft of the femur allows for early mobilization, thereby reducing the risk of hip and knee stiffness as well as quadriceps and hamstring wasting. In this report, we present the case of a 16-year-old girl with an alleged history of fall who was admitted to Acharya Vinobha Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS) Deemed To Be University (DU), Wardha, India, with primary complaints of pain and swelling over the left thigh. She was diagnosed with a left midshaft femur fracture. An open reduction internal fixation (ORIF) femur interlock nailing was performed to stabilize the fracture, and she was referred to physiotherapy after surgery for further management. The comprehensive rehabilitation program was helpful in alleviating the severe kinesiophobia in the patient, and she was able to resume her activities of daily living (ADLs) independently.

A 7-year-old female, born out of a non-consanguineous marriage, presented with an extreme posturing of the spine. As per her father, she had a history of delayed birth cry and recurrent episodes of seizures. She was diagnosed with quadriplegic cerebral palsy with epilepsy. She was referred by an orthopedic surgeon to the department of physiotherapy for evaluating if the spinal deformity was fixed or flexible, so that the further line of management could be determined. On observation of her posture in supine lying (A) and in prone lying (B), marked lordoscolios was noted along with hyperlordosis. Examination revealed spasticity of grade 3 on the modified Ashworth scale (MAS) in spinal extensor muscle group. She was neither able to roll over nor was she able to sit even with extensive support. The posturing of the spine posed difficulties for caregivers during feeding, dressing and during activities to maintain hygiene. In an attempt to examine flexibility of the spine, child was placed prone on the lap by the physiotherapist. Slow vestibular stimulus in the form of rocking movements was given by the movement of the physiotherapist´s thighs. As the child displayed some relaxation of trunk muscles, the physiotherapist clasped her hands below her knees providing a firm pressure to the child´s back through her arms. This further inhibited the resistance offered by the child´s muscles and the spine could be aligned to near neutral in the sagittal as well as in the coronal plane revealing the flexible nature of the deformity (C).

Xia-Gibbs syndrome (XGS) is a recently discovered genetic disorder. It is characterized by global developmental delay, intellectual impairment, hypotonia, and sleep abnormalities. While the current literature emphasizes on the genotype and phenotype of this rare condition, it does not provide any description of the physiotherapy management of patients with XGS. We report a case of a 27-month-old Indian male diagnosed with XGS, who presented with difficulty in sitting without support. He had dysmorphic facies, hypotonia, hyperextensible joints, mild kyphoscoliosis, and global developmental delay. His parents and an elder female sibling were clinically asymptomatic. The physiotherapy intervention was based on the principles of neurodevelopmental treatment (NDT) and sensory integration (SI). The management included facilitation of transitions, weight-bearing exercises, wheelbarrow walking, joint compressions, rib cage mobilization, multidirectional reaching, and pushing-pulling activities along with the use of equipment like Swiss ball, balance board, stability disc, trampoline, swing system, walker (rollator), and walking harness. Also, stabilizing pressure input orthosis (SPIO) for the trunk and ankle-foot orthosis (AFO) followed by supramalleolar orthosis (SMO) were used for support. Thereafter, the child was able to stand and walk without support at the age of 36 months, and walk on uneven terrain at the age of 42 months. In addition, he could negotiate stairs using handrails with mild assistance. His gross motor function measure-88 (GMFM-88) total score improved from 21% at the presentation to 66.6% following the treatment. It was observed that the NDT and SI approaches along with the use of appropriate orthoses accelerated the achievement of motor milestones in this case. To the best of our knowledge, this is the first case report of a child with XGS that emphasizes on the course of physiotherapy management for the associated motor delay.

Encephalitis refers to inflammation of the brain parenchyma. It is potentially life-threatening with the highest incidence and severity in younger children. Febrile infection-related epilepsy syndrome (FIRES) is a condition, in which a child develops a nonspecific febrile illness that may not persist when the initial seizure activity begins. However, an electroencephalogram (EEG) shows that the child is in status epilepticus. We report the case of a five-year-old male who presented with difficulty to maintain sitting posture, and inability to stand and walk without support, following viral encephalitis at the age of one year. He had motor, visual, speech and cognitive impairment along with a seizure disorder. The physiotherapy interventions including neurodevelopmental treatment (NDT) and sensory integration (SI) helped in regaining locomotion ability in the child. The study aims to assess the impact of physiotherapy interventions on regaining locomotor ability in a child with FIRES following infective encephalitis.

Background: The international continence society defines urinary incontinence (UI) as a situation in which involuntary urine loss is a hygienic or social issue and can be demonstrated objectively. Due to culture of silence, Indian females with urinary issues are quietly suffering from symptoms even when their symptoms trigger great discomfort and hamper regular activities. In India, there are limited research dealing with the effect of UI among rural females. Aim: The aim of the study was to determine the effect of vaginal cones and perineometer as a biofeedback device in rural females with UI. Objective: The objective of the study was to compare the effect of vaginal cones along with perineometer as a biofeedback device versus pelvic floor exercise in rural females with UI. Procedure: A comparative study included 45 participants aged 45–70 years as per the inclusion criteria which were divided into two groups: Group A was treated with vaginal cones and perineometer, whereas Group B was given Kegel exercises. Pre- and postreadings of questionnaire for female UI diagnosis and perineometer were taken. Results: The analysis of the result showed a significant improvement in Group A as compared to Group B. Conclusion: The present study concluded that a combined effect of vaginal cones and perineometer with biofeedback device showed a more significant result than pelvic floor muscle strength training (Kegel exercise).

Fetus in fetu is a rare condition not usually considered in the differential of a neonatal abdominal mass. This article illustrates the importance of prenatal ultrasound in the treatment of this condition as it facilitated the assembily of a multispecialty healthcare team that intervened within days of birth.