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Physiotherapy for Respiratory and Cardiac Problems

Introduction Flat foot (pes planus) is a commonly observed disorder in clinical practice. The height of Medial Longitudinal Arch (MLA) determines the degree of pes planus. Majority of the previous studies on prevalence of flexible flat foot were done among children. Aim The present study was undertaken to determine the prevalence of flexible flat foot among 18-21-year-old Indian adults using Navicular Drop Test (NDT) which is regarded as reliable and valid method to characterise MLA. Materials and methods The present study was a cross-sectional study in which Brody's Navicular Drop Test was performed in five hundred healthy subjects (250 males and 250 females) aged 18-21-year-old. Navicular Drop (ND) of ≥ 10 mm was regarded as flexible flat foot. Statistical analysis was done using SPSS version 23.0. Results The prevalence of flexible flat foot was 13.6% (for males-12.8%; for females-14.4%). The median with Inter Quartile Range (IQR) for ND among males was 6 mm (4-8) and 6 mm (4-9) for right and left foot respectively. The median with IQR for ND among females was 6mm (4-10) and 7mm (3-8) for right & left respectively. The correlation of Right Side Navicular Drop (RND) with height and weight was significant, but insignificant correlation was found between RND and BMI. The correlation of Left Side Navicular Drop (LND) with height, weight and BMI of individuals was statistically not significant. The difference between the ND of males and female group was statistically not significant. Conclusion The present study quantified the prevalence of flexible flat foot and gender wise normative values of ND among 18-21-year-old Indian adults. The information obtained by this study will be useful in the field of orthopaedics.

Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study.

Flatfeet: Biomechanical implications, assessment and management

Population ageing. Biological theories of ageing. Physiological changes in the ageing of the foot and ankle. Epidemiology of foot problems in older people. Functional implications of foot problems in older people. Assessment of the older patient. Common foot problems and their management. Foot and ankle manifestations of common systemic conditions. Wound management in older people. Footwear and orthotic considerations. Surgical considerations. Outcome measurement. Geriatrics as a speciality area.

Foot problems in older people : assessment and management by Hylton Menz, 1st edition

Chest physiotherapy (CPT) is used frequently in the ICU, but there is little available information that quantitates its effect on cardiac or respiratory function. Nineteen mechanically ventilated patients with posttraumatic respiratory failure were studied before, immediately after, and 2 h after CPT was used to manage secretion retention. Cardiac index was unchanged, but there was an immediate decrease in intrapulmonary shunt, followed 2 h later by an increase in lung/thorax compliance. We did not find the reduced cardiac output reported by others. The reasons for this may include use of different CPT techniques, a young patient population (mean age 32.4 yr), and mechanical ventilation with positive end-expiratory pressure. CPT did not produce the deletrious cardiopulmonary changes associated with bronchoscopy, and it reduced retained lung secretions without producing hypoxemia. Intrapulmonary shunt and lung/thorax compliance were significantly improved, but the long-term clinical effect of these changes is unknown.

Cardiorespiratory function before and after chest physiotheraphy in mechanically ventilated patients with post-traumatic respiratory failure

Background: Pes-planus (’flat foot’) is one of the most common conditions observed in adult health practice. The objective of our study wasto find out prevalence of flat foot in a population of 18 to 25 year old physiotherapy students and to find out correlation of BMI with arch index Methodology: A cross sectional study was conducted with sample of 80 physiotherapy students fitting in inclusion criteria. Different outcome of the study that is navicular drop test, arch index, foot posture index were assessed for each subject. Result : Prevalence of flat foot in a population of 18 to 25 years old physiotherapy students was 11.25% for all subject affected with bilateral flat foot. According to theage, 18 years were having 2.5% of flat foot bilaterally, 19 years were having 3.75% flat foot bilaterally, 22 years were having 3.75 % flat foot bilaterally, 24 years were having 1.24% flat foot bilaterally. The mean Navicular drop test value was 11.11 for all subject affected with bilateral flat foot and 6.66 for normal subjects & pronation score (FPI) for flat foot subjects mean was 7.44 (+6 to +11) bilaterally. Conclusion: From our study we concluded that, prevalence of flat foot in a population of 18 to 25 years old physiotherapy students was 11.25% and all subject affected with bilateral flat foot. There was no significant difference according to gender & there is no correlation of

Prevalence of flat foot among 18 -25 years old physiotherapy students: cross sectional study

Background: With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. Materials and methods: Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. Results: The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. Conclusion: This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. How to cite this article: Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

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Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup.

Background: Chest physiotherapy (CPT) and positioning of neonates has been used in many developed countries around the world to improve airway clearance and avoid lung complications, but the combined effect of both techniques is less documented. The objective of the study was to compare the effectiveness of chest physiotherapy in prone position versus conventional chest physiotherapy in ventilated neonates on respiratory outcomes. Methods: The study design was randomized controlled pilot study. Participants: 12 ventilated neonates fitting in Inclusion Criteria. They were randomly divided into two groups (n=6 in each group) using simple random sampling i.e. Experimental group (4female and 2male) (Chest Physiotherapy and Prone Positioning) and the Control group (3 females and 3males) (Conventional Chest Physiotherapy). Primary outcome measures were SpO2 saturation, Partial Pressure of Arterial Oxygen (PaO2) & Peak Inspiratory Pressure (P.I.P.). Outcomes were recorded Pre & Post of every 120 minutes session of Intervention twice daily with a gap of 6 hours for consecutive three days for the experimental group while for the control group, parameters were measured at the same time of the day. Result: Total 10 participants completed the study protocol. On comparison of three parameters in two groups using the unpaired t-test we found that there was a significant difference (p< 0.05) in SpO2 and PaO2 in both groups but no difference ( p >0.05) in P.I.P. levels. Conclusion: Chest physiotherapy in the prone position for ventilated neonate concluded with a higher oxygen saturation (SpO2) and partial pressure of oxygen in the arterial blood (PaO2) when compared to conventional chest physiotherapy.

The Effectiveness of Cardiopulmonary Physiotherapy Versus Prone Positioning on Respiratory Functions in Ventilated Neonates:A Randomized Controlled Pilot Study

Background: Low back pain is experienced in 60%-80% of young adults at some point of their lifetime, affecting the daily activities of many people. Various cardiovascular changes occur during exercise- it meets the increased demand placed on the system and carries out its function with maximal efficiency. So the purpose of the study to find out effect of lumbar core muscle stability exercises on cardiovascular parameters in young adults.
Aim: To find out effect of lumbar core muscle stability exercises on cardiovascular parameters in young adults.
Method: Total 40 patients of age 20-30 were included in the study. Two groups were made. Group A with normal healthy young adults and Group B with Postural Low Back Pain. Baseline parameters like HR, RR, BP were noted as L1. Participants were asked to draw the belly inwards and hold for 10 seconds with 10 repetitions. After exercise baseline parameters were noted as L2. 
Results: Paired t-test was used to compare in the groups and unpaired t-test was used to compare in between the two groups. There was significant increase in the cardiovascular parameters of both the groups. 
Conclusion: The study concludes that the lumbar core muscle stability exercises exert significant effects on the cardiovascular parameters of healthy young adults as well as young adults with postural low back pain.

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Effect of Lumbar Core Muscle Stability Exercises on Cardiovascular Parameters of Young Adults- A Cross Sectional Study

Background: Trismus is a restricted mouth opening due to the tonic contraction of muscles of mastication. It may occur mostly in HNF cancer patients undergoing radiation therapy treatment. This study was undertaken with the purpose of finding out the prevalence of trismus in patients undergoing radiation therapy. Method: 89 patients with HNF cancer patients receiving radiation therapy were included in the study. Inter incisal distance was measured using sliding digital vernier calliper. Patients with ≥ 35mm mouth opening were considered as trismus cases. Result: Out of 89 patients included 72 were diagnosed as trismus; hence the prevalence was 81%. Conclusion: Prevalence of Trismus is very high ( 81 %) in patients undergoing radiotherapy secondary to HNF cancer. Early diagnosis of trismus in these patients can help in time management and also planning of preventive strategies.

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Abhijit Diwate

Papers

Prevalence of flat foot among 18 -25 years old physiotherapy students: cross sectional study

Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup.

The Effectiveness of Cardiopulmonary Physiotherapy Versus Prone Positioning on Respiratory Functions in Ventilated Neonates:A Randomized Controlled Pilot Study

Effect of Lumbar Core Muscle Stability Exercises on Cardiovascular Parameters of Young Adults- A Cross Sectional Study

Prevalence of trismus in HNF Cancer patients undergoing radiation therapy: A cross-sectional study