Circuit exercise therapy is being frequently used as a therapy option for stroke patients undergoing rehabilitation. However, the effectiveness of this therapy in improving post-stroke functionality remains limited. There is also a need to improvise the content of the existing circuit exercise therapy to further enhance the process of neuroplasticity towards the attainment of greater recovery. One strategy for this is to integrate the element of games into the exercise therapy to create a more enriched training environment during the exercise session. This study aimed to determine the feasibility and effectiveness of a game-based circuit exercise therapy among stroke survivors. This was a pilot experimental study involving 30 stroke patients at post-acute phase post-onset (mean age and standard deviation = 58.9 ± 6.6 years; mean Montreal Cognitive Assessment score = 23.4 ± 7.1) and conducted in a district of Kelantan, Malaysia. Simple random sampling method was used in recruiting the study participants. All participants undergone game-based circuit exercise therapy using a game board named “Checkercise” for 45 minutes, twice per week for 8 weeks. The feasibility of the therapy was measured in term of attrition rate, occurrence of adverse effects and feedbacks from the participants. While its effectiveness on post-stroke physical function were assessed with regards to improvement in functional stability and cardiovascular endurance, using Dynamic Gait Index (DGI) and 6-minute Walk Test, respectively. All data were analyzed using the paired samples t test, with the level of significance, p set at < 0.05. Study results shown low attrition rate, no apparent adverse effect, and positive feedbacks from the participants. Improvement in the participants’ mean score for DGI and 6-minute walk test by 7% and 23% respectively (p < 0.05), and medium effect size (Cohen’s d= 0.5 - 0.6) was obtained post-therapy. In conclusion, game-based circuit exercise therapy is feasible and beneficial for stroke survivors. The therapy can potentially be used as a therapy option for this population. A larger study is needed to confirm this study finding.
The study evaluated the function of median sensory nerve fibers, as well as determining the relationship between its function with the duration of Carpal Tunnel Syndrome (CTS) and body mass index (BMI) among CTS patients in Physiotherapy Unit, Universiti Kebangsaan Malaysia Hospital (HUKM). Thirty subjects (6 males and 24 females) with mean age 53.30 +/- 9.20 years and duration of the CTS 51.17 +/- 50.22 months participated in this study. The sensitivity of median sensory nerve was evaluated using Current Perception Threshold (CPT) Test with stimulation frequencies of 5 Hz, 250 Hz and 2000 Hz; which demonstrated the function of C, A-delta and A-beta nerve fiber respectively. Majority of the CTS patients had normal function in the 3 types of median sensory nerve fiber. Forty percents of the subjects had abnormality in the Aa function, 7% had abnormality of the A-beta function and 27% demonstrated abnormality in the C fiber function. Spearman Correlation Test showed no significant relationship between the function of median sensory nerve and the duration of CTS and body mass index (BMI) (p > 0.05). In conclusion, although majority of the patients demonstrated normal median sensory nerve function, abnormality of the A-beta, A-delta and C fibers sensitivity in some patients requires attention to prevent worsening of the nerve function thus avoiding related complications. Physiotherapists in HUKM may intensify the use of nerve stimulating modalities such as Transcutaneous Electrical Nerve Stimulation (TENS) to normalize the nerve functions of these patients.
Keywords: Carpal Tunnel Syndrome; Current perception threshold; Median sensory nerve sensitivity; Body mass index
Study site: Physiotherapy Unit, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
This study identified the effectiveness between home-based and hospital-based pulmonary rehabilitation program on the quality of life of chronic obstructive pulmonary disease (COPD) patients. Thirty five patients who met the inclusion criteria were referred by physicians and randomized to either hospital-based pulmonary rehabilitation (PRPH) or home-based pulmonary rehabilitation (PRPR). The PRPH program was scheduled twice a week for eight weeks at the Physiotherapy Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Whilst, the PRPR group was required to attend sessions at the Physiotherapy Department twice to learn the exercise regimens before carrying out the exercises themselves at home. Subjects were asked to record activitites in a diary and a telephone call was made once every two weeks to ensure compliance towards the exercise regimens. The SF-36 questionnaire and Geriatric Depression Scale were outcome measures used in assessing status of patients prior to treatment and after intervention at the 8th week Seventeen (48.6%) subjects completed the PRPH and 15 (43%), the PRPR. Results indicated that in the PRPH group there were significant improvements in some of the domains of SF-36, i.e., role physical (p = 0.012) body pain (p = 0.040), general health (p = 0.008) and role emotional (p = 0.012). In the PRPR group, the Geriatric Depression Scale mean score was 1.8 ± 0.41 at baseline compared to 1.69 ± 0.48 following intervention (p > 0.05). Whilst, among the PRPH group, the mean was 1.87 ± 0.35 at baseline and 1.53 ± 0.52 after eight week (p < 0.05). In conclusion, hospital-based pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the quality of life and reducing depression among patients with COPD.
Keywords: Home Based Pulmonary Rehabilitation Program (PRPR); Hospital based Pulmonary Rehabilitation Program (PRPH); COPD; Quality of life (QOL).
Despite being becoming popular and heavily used in rehabilitation, the evidence on the effectiveness of Virtual reality-based therapy (VRBT) among persons with knee osteoarthritis (OA) remains limited. The aim of this study was to determine the effects of VRBT on walking endurance and quality of life of older persons with knee OA in comparison to conventional exercise therapy. This was a randomised controlled trial involving 44 participants (mean age and standard deviation = 66.32 ± 5.73 years) who received either a VRBT (experimental group, n = 22) or a conventional exercise therapy (control group, n = 22) for 45 minutes, twice per week for 12 weeks. The outcome of both therapies on walking endurance was measured using Six-Minute Walk Test (6 MWT), while quality of life was assessed using the Malay-version of Short Form-36 (SF-36). Analysis was done by ‘intention-to-treat’ approach, using Mixed Model ANOVA. A significant time-effect (p < 0.05), with large effect size between 0.43 and 0.54 were found for all outcomes following the therapies. An increase of 17% and 19% of 6 MWT scores were obtained in experimental and control group, respectively. Meanwhile, the scores for the physical and mental components of the SF-36 increased by 37.8% and 19.4% in the experimental group, and 45.7% and 20.6% in the control group. However, no significant group and interaction effects were found for all outcomes (p > 0.05). In conclusion, VRBT is comparable with conventional exercise therapy in improving walking endurance and quality of life of persons with knee OA, and can be used as a therapy option for this population.
Enhancement of physical function had been shown in older adults who actively participate in physical activities, particularly in the form of aerobic training with addition of progressive resistance training (PRT). However, it is quite challenging and risky for most older adults to exercise in standing position without any support. Chair Based Exercise (CBE) is an alternative mode of exercise for older adult to facilitate exercise participation and increase safety. Its effect when combined with resistance training is unknown to date. Therefore, the aim of this study was to evaluate the outcome of CBE with PRT on physical performances among older adults. A total of 18 older adults (13 females (72%)) and 5 males (28%)), aged 60 to 83 years with mean age (SD) 72.67 (6.17) years completed the study. All subjects performed CBE with PRT intervention twice weekly for 8 weeks, with individually-tailored exercise progressions. Pre and post measurements of physical performance were performed using Six MinutesWalk Test (6MWT), Five Times Sit to Stand (FTSTS) and Hand Grip Strength (HGS) test. Significant improvement in 6MWT (p < .001), HGS Right hand (p = .043), HGS Left hand (p < .001), FTSTS (p < .001) was shown after the eight-week intervention. Adding PRT into seated exercises results in further improvement in physical performance of older adults. CBE-PRT may be recommended as an exercise routine for older adults living in the community.
Neurophobia, defined as ‘the fear of neural sciences and neurology’ is reported among medical students, which threatened their performance in neurology course. This phenomenon has not been studied among rehabilitation sciences students despite the significance of neurology as an area for rehabilitation. In this study we aim to assess the perceptions of neurology course and the possibility of neurophobia existence among rehabilitation sciences students of Universiti Kebangsaan Malaysia (UKM). We also aimed to identify learning methods which are regarded as useful among the students. A survey using self-administered questionnaires was conducted among 73 students from School of Rehabilitation Sciences of the university. Questions in the questionnaire were adapted from previous studies, in which neurophobia was indicated by poor knowledge and low confidence level in managing neurology course. Results showed that the percentage of participants who perceived having good knowledge of neurology was significantly higher than the percentage who claimed of having poor knowledge level (90.4% versus 9.6%, p < 0.01). Similarly, the percentage of participants who claimed having high confidence to handle neurology cases was higher than the percentage who expressed lack of confidence (79.2% versus 20.8%, p = 0.03). However, neurology course was perceived as difficult by majority of the participants (78.1%) when compared to other courses. Majority of the participants (97.3%) perceived clinical teaching as a useful method of learning rehabilitation science courses including neurology followed by problem-based learning (90.4%). While limited exposure to neurology cases was claimed as the main reason to why neurology is difficult. In conclusion, although neurology is perceived as a difficult course among rehabilitation sciences students, the students did not report lack of knowledge and confidence in the course. This implies that neurophobia does not exist among UKM rehabilitation students. Enhancement of learning methods may assist in reducing the level of difficulty of neurology course among the students.
Balance and motor skills are essential prerequisites for physical development of a child. The aims of this study were to measure anthropometrics, postural balance and motor skills; and examine their correlation among healthy preschool children. Forty nine healthy preschool children aged between 3 to 4 years old participated from PERMATA preschool organization. Pediatric Balance Scale and Peabody Development Motor Scale-2nd Edition (PDMS-2) were administered to measure balance skills for both fine and gross motor skills respectively. Mann-Whitney U test demonstrated that there was no significant difference in balance (p=0.72) and motor skill (p=0.33) between boys and girls. Spearman correlation coefficient demonstrated that there was significant correlation between balance skills with height (r=0.45, p=0.001) and body mass index(r=0.47, p=0.001). No significant correlation was found between balance skills and motor skills (r=0.11, p=0.44). The present study suggests that balance skills in healthy preschool children aged 3-4 years old are correlated with their physical growth such as height and weight but not motor skills.
Falls are a public health concern among older adults. There is a need to take significant measures such as screening for the risk of a fall as a means of prevention and management. A cross-sectional study was conducted to determine discriminative and predictive ability of physical performance measures in identifying the risk of fall among Malaysian community dwelling older adults. Three hundred twenty-five Malaysian community dwelling older adults aged 60 years and above (67.67+ 5.5 years) participated in this study. This study was a part of a larger longitudinal study ‘LRGS TUA’. Physiological Profile Assessment (PPA), a comprehensive tool for quantifying risk of fall was used as a standard measure of comparison to 6 Meter Gait Speed (GS), Timed Up and Go (TUG) and Walking While Talking (WWT) tests to establish discriminative and predictive ability. Participants recorded incidence of falls in a ‘falls diary’ over a span of six months. To determine the optimum cut off scores of the test identified to classify fall risk, receiver operator curves (ROC) were used and its sensitivity and specificity were calculated. A significant mean difference between fallers and non-fallers was demonstrated only with TUG test (p<0.05). TUG test cut off score in discriminating older adults at risk of fall was established at eight seconds, with a sensitivity and specificity of 83.95% and 32.4%, respectively, in this study. Eighty-four percent older adults who experienced a fall in our study were identified to be at risk of fall when screened using this TUG cut off score. Our study results suggested TUG test to be an optimal screening tool for risk of fall among community dwelling older adults.
Involvement of informal carer in post-stroke care is important to prevent development of secondary complications particularly among stroke survivors with severe disability. However, to date, evidence on the benefit of stroke care training and involving carer to assist in the care for this group of stroke survivors is still limited. In this study, we evaluated the outcome of a carer-assisted care program for stroke survivors with severe disability who live at home. Sixteen stroke survivors with severe disability and 16 primary carers participated in this pre-test post-test intervention study. Carers were trained using a stroke care module which was developed by a group of multidisciplinary researchers from Universiti Kebangsaan Malaysia, prior to implementing the daily care for 8 weeks. Outcome of care on stroke survivors was assessed in term of change in disability level and quality of life using Modified Barthel Index (MBI) and EuroQol health-state measure (EQ-5D and EQ-VAS), respectively. While outcome of stroke care training on carer was determined using Modified
Caregiver Strain Index (MCSI). Significant improvement is shown in the stroke survivors’ EQ-VAS component of EuroQol health state measure (average increase by 12%, t = 2.86, p = 0.01) following the care. Although not statistically significant (t = 0.97; p = 0.35), the mean score of MCSI reduced by 14%. No significant change was found in the MBI of the stroke survivors at completion of the program. Carer-assisted care is useful in improving quality of life of stroke survivors and can potentially reduce stress level among carers. Larger study may assist in establishing these preliminary findings.