Nigerian Journal of Medical Rehabilitation
The Nigerian Journal of Medical Rehabilitation is a multidisciplinary and peer-reviewed journal. This journal was established to meet the demands and challenges of health care delivery in the 21st Century in Nigeria and other countries with similar setting in the ever-changing world of science and technology.
Medical Rehabilitation Therapists Board of Nigeria
Evaluation of the Challenges of Continuing Professional Development Training among Clinical Physiotherapists in Nigeria
<a title="ABSTRACT" href="Background: Training and development are essential for acquisition of clinical skills for better competence, relevance and efficiency. In view of this, it is important to continually appraise training and professional development in the field of physiotherapy. The main objective of this study was to evaluate the challenges of continuing professional development training among clinical physiotherapists. Methods: Three hundred and fifty one clinical physiotherapists were recruited using sample of convenience. Data were collected through the creation of a google form questionnaire which sought for relevant information on sociodemographic details, work settings, source of information on Continuing Professional Development (CPD), impacts, challenges and barriers to attending CPD training. The google link were provided to two professional bodies of physiotherapy in Nigeria. The data were collated and analyzed using descriptive statistics and Chi- square test of association to determine the association between CPD and and selected sociodemographic variables, alpha Level being p≤0.05. Results: The result showed the ages of the physiotherapists ranged from 20 to 59 years. Most respondents sourced for information about CPD through the social media using WhatsApp medium (84.7%) and among colleagues (76.1%). Majority (90.9% and 80.1%) of the respondents reported that CPD contributed to career advancement and the improvement of clinical skills, respectively. Furthermore, the respondents faced different challenges in engaging in CPD training which included high cost of registration (61.5%), time constraints (26.2%), non-provision of adequate support to participate (59.5%) and lack of relevant programs 13 (3.7%). Conclusion:In conclusion, the main challenges of attending CPD training are due to huge cost of participation, time constraint due to heavy workload and lack of adequate support from employers. Almost all the physiotherapists acknowledged that CPD training contributed to career advancement and the improvement of clinical skills and were receiving most information from the social media and among colleagues. Key words: Evaluation, CPD, Constraints, Clinical Physiotherapists">Background: Training and development are essential for acquisition of clinical skills for better competence, relevance and efficiency. In view of this, it is important to continually appraise training and professional development in the field of physiotherapy. The main objective of this study was to evaluate the challenges of continuing professional development training among clinical physiotherapists. Methods: Three hundred and fifty one clinical physiotherapists were recruited using sample of convenience. Data were collected through the creation of a google form questionnaire which sought for relevant information on sociodemographic details, work settings, source of information on Continuing Professional Development (CPD), impacts, challenges and barriers to attending CPD training. The google link were provided to two professional bodies of physiotherapy in Nigeria. The data were collated and analyzed using descriptive statistics and Chi- square test of association to determine the association between CPD and and selected sociodemographic variables, alpha Level being p≤0.05. Results: The result showed the ages of the physiotherapists ranged from 20 to 59 years. Most respondents sourced for information about CPD through the social media using WhatsApp medium (84.7%) and among colleagues (76.1%). Majority (90.9% and 80.1%) of the respondents reported that CPD contributed to career advancement and the improvement of clinical skills, respectively. Furthermore, the respondents faced different challenges in engaging in CPD training which included high cost of registration (61.5%), time constraints (26.2%), non-provision of adequate support to participate (59.5%) and lack of relevant programs 13 (3.7%). Conclusion: In conclusion, the main challenges of attending CPD training are due to huge cost of participation, time constraint due to heavy workload and lack of adequate support from employers. Almost all the physiotherapists acknowledged that CPD training contributed to career advancement and the improvement of clinical skills and were receiving most information from the social media and among colleagues. Key words: Evaluation, CPD, Constraints, Clinical Physiotherapists
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Cardio-respiratory physiotherapy training experience: perceptions of final-year Nigerian physiotherapy undergraduates
https://docs.google.com/document/d/1-1uyC0ke1BeOWSVpblrzMxo5KpLV6KWnwnMDHALQU6Y/edit
Association of Complaints of the Arm, Neck And Shoulders with Hand Grip Strength and Neck Load in Building Construction Workers- A cross-sectional study
Background: The literature regarding how neck load and hand grip strength (HGS) influences the report of complaints of arm, neck and shoulder CANS among building construction workers is sparse. Objective: This study assessed the association of CANS with HGS and load carrying capacity of the neck in building construction workers. Methods: A cross-sectional design involving 174 consenting building construction workers in 15 construction sites of a metropolitan city. Participants were recruited using consecutive sampling. Participants’ age were obtained while weight, height, neck strength, hand grip strength, and load carried on the neck were measured with standard instruments. The Maastricht Upper Extremity Questionnaire was used to evaluate CANS. Data was summarised using frequency and percentages, and analysed using inferential statistics of Chi-square and Pearson moment correlation coefficient at p < 0.05. Results: The findings revealed a high prevalence of neck complaints (93.1%) and musculoskeletal pain (98.1%). Participants overall load was significantly associated (χ2=134.66, p= 0.027) with the experience of musculoskeletal pain, while HGS was significantly associated (χ2=401.78, p= 0.032) with shoulder complaint. A significant negative weak relationship (r=-0.17, p=0.030) was found between age and neck load, while a significant positive weak relationship (r= 0.18, p=0.020) was found between neck flexor muscle strength and neck load. Conclusion: Neck pain and complaints are highly prevalent in building construction workers who carry loads on their neck. The load carried by building construction workers is associated with their experience of musculoskeletal pain. Also, HGS is associated with shoulder complaints in building construction workers.
Topic: Effects of combined graded activity and motor control exercises on selected biopsychosocial parameters among nonspecific chronic low back pain patients in Nigeria-A pilot study
Background Low back pain is increasingly recognised as a major health problem in Africa. Individuals with this condition are burdened not only by pain and disability but by an array of psychosocial dysfunctions as unhealthy behaviours, beliefs and reduced quality of life. Non-specific chronic low back pain is multifactorial in nature, and no single intervention is optimal for these patients. Objectives To evaluate the logistics, feasibility and minimum sample size of conducting a randomised controlled trial (RCT) on effects of combined graded activity and motor control exercises on selected biopsychosocial parameters among nonspecific chronic low back pain patients. To determine minimal clinically important changes of the selected biopsychosocial parameters. Methods The study is a pre-test post-test single-group experimental design. Ten patients with non-specific chronic low back pain were managed twice a week for six-weeks using a combined graded activity with motor control exercise intervention. Primary outcome measured were pain intensity and functional disability measured using the numerical pain rating scale and Oswestry disability index questionnaire. Secondary outcome measured were pain catastrophizing, fear avoidance beliefs, quality of life, and kinesiophobia measured using the pain catastrophic scale, fear avoidance beliefs questionnaire, SF-36 and Tampa scale of kinesiophobia (TSK-11) respectively. All outcomes were assessed at baseline and immediately after six-week intervention. Descriptive statistics of frequencies, percentages, mean and standard deviation was used to describe the participants’ sociodemographic variables and the questionnaires. Paired sample t-test was used to determine if significant changes in primary and secondary outcomes were observed. Results Feasibility findings show (77%) recruitment rate, (100%) patients’ adherence, and retention respectively. Adverse events due to intervention were not reported. Pain intensity, functional disability, pain catastrophizing, quality of life, and kinesiophobia demonstrated statistically significant improvement (p<0.01) and clinically relevant changes among the patients. Pain intensity and functional disability show a minimal clinical important change (MCIC); MCICNPRS=4.2±1.68 and MCICODI=13.6±3.9 respectively. Conclusions Feasibility findings show a high recruitment rate, patients’ adherence, and retention respectively. Adverse events due to intervention were not found. Pain intensity, functional disability, pain catastrophizing, quality of life, and kinesiophobia demonstrated statistically significant improvement (p<0.01) and clinically relevant changes among the patients. Pain intensity and functional disability show a minimal clinical important change (MCIC); MCICNPRS=4.2±1.68 and MCICODI=13.6±3.9 respectively. Keywords: Graded activity exercises; Motor control exercises; Chronic low back pain; Non-specific; Biopsychosocial factors; Combined graded activity and motor control exercise (CGAMCE)
Comparative Effectiveness of Cervical Stabilization Exercises and Vertical Oscillatory Pressure in the Management of Patients with Cervical Spondylosis
Background: The prevalence of spinal pain reported is that more than a third of a billion people worldwide suffer from mechanical neck pain implicating degenerative cervical spondylosis. The burden of management of this condition lies with functional rehabilitation experts. Objective: The study determined the comparative effectiveness of cervical stabilization exercises (CSE) and vertical oscillatory pressure (VOP) in the management of patients with cervical spondylosis. Methods: The experimental study involved 40 patients with neck pain arising from cervical spondylosis. Informed consent was obtained and participants were assigned the two treatment groups of twice weekly regimen for six weeks. Treatment effects were assessed on pain intensity, anxiety level, disability index, health related quality of life and cervical range of motion using Visual Analogue Scale, Beck Anxiety Inventory, Neck Disability Index, Short Form-12 questionnaire, and goniometer respectively at baseline, third and sixth weeks. Inferential statistics of Independent T-test, Paired T-test and Repeated Measure ANOVA were used to analyze data. Alpha level was set at p˂0.05 of significance. Results: The results showed VOP had significant effect on all variables while CSE also had significant effect on the variables except health-related quality of life (p = 0.382). Conclusion: CSE and VOP were effective in the management of cervical spondylosis. However, VOP should be preferred when improvement on quality of life is desired. VOP may be administered by physiotherapists on patients as part of the rehabilitation protocol to effectively manage neck pain arising from cervical spondylosis. Keywords: Manipulation, Exercise, Cervical Spondylosis, Neck Pain, VOP
The Impact Of Internship Programme And Its Effects On The Physiotherapy Practice In Nigeria
Background: The recent introduction of one year internship training programme is one of the few steps taken to update standard and knowledge of upcoming physiotherapists in Nigeria. It is a compulsory one-year clinical training post-graduation from the university under the supervision of the clinicians. The major importance of introducing the new policy is to promote acquisition and utilization of new skills, and as well, develop skills and confidence already acquired during undergraduate days. Objectives: The aim of this study was to assess and evaluate the new internship-training programme considering welfare package like salary and wages, accommodation, employment opportunities, acceptability and working environment. The study also evaluated the opinion of the supervisors on the impact of the new policy on the profession, government and clinical practice. Method: Structured copies of self-administered questionnaires were distributed to forty-four interns at three accredited University Teaching Hospitals in Nigeria while 30 questionnaires were distributed to supervising physiotherapists in these hospitals. The response rate for interns was 100% while it was 60% for the supervisors. The data obtained from the designed questionnaire were analyzed by descriptive analysis. Results: The result showed that the 52% of the interns were satisfied with the support from their senior colleagues, work load (80%), freedom to plan and manage patients (100%), and supervision from senior colleagues (62%). They were grossly dissatisfied with their salaries (91%), equipment available (79%), pattern of conducting ward rounds (89%), and office environment (58%). The result also revealed that all the supervising physiotherapists (100%) were satisfied with the skill and clinical practice of the interns. The result further showed that the programme has a positive impact in terms of clinical practice, confidence employment opportunity, productivity and government policy (66–100%). Conclusion: This study concluded that the internship programme has a remarkable positive impact on the profession of physiotherapy in Nigeria. However, the intern physiotherapists were not satisfied most especially with their monthly income and pattern of conducting clinical rounds. KEY WORDS: Physiotherapy Internship Programme, Nigerian Physiotherapists.
Relative therapeutic efficacy of ketoprofen iontophoresis and transcutaneous electrical nerve stimulation in the management of osteoarthritic knee pains: a pilot study
Background: Osteoarthritis (OA), also known as degenerative joint disease, has no curative treatment. However, pharmacological therapies such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and more recently etodolac (iodine) are commonly used in its treatment. Non-pharmacological therapy, predominantly physiotherapy, is also employed in the treatment of OA. Objective: This research was aimed at determining the relative therapeutic effectiveness of ketoprofen iontophoresis and transcutaneous electrical nerve stimulation in the management of osteoarthritic knee pain. Methods: Twenty subjects with diagnosis of OA of the knee joint were randomly selected into the ketoprofen iontophoresis group and the transcutaneous electrical nerve stimulation group. Both groups received quadriceps strength training in addition to their group therapy. Each subject, who had 3 sessions per week over a four-week period, had a total of 12 treatment sessions. Each treatment session lasted 45 minutes. Results: There was a statistically significant decrease in pain intensity and increase in range of motion in both groups but no significant difference in change in both outcome measures between the groups. Conclusion: Management of OA of the knee using either ketoprofen iontophoresis or transcutaneous electrical nerve stimulation in addition to quadriceps strengthening exercises in this pilot study was shown to be effective in pain reduction and to increase range of motion. Neither of the interventions was superior. Future studies using a larger sample size are needed to confirm our findings.
Effects of Transcutaneous Electrical Nerve Stimulation (TENS) On Hormone profiles In Subjects With Primary Dysmenorrhoea - A Preliminary Study
Background & Objective: Primary dysmenorrhoea (PD) is the occurrence of painful menstrual cramps of uterine origin which occurs in the absence of any underlying disease. The objective of this study was to evaluate the effect of TENS on the hormones; cortisol and prolactin in individual with PD. Methods: Plasma levels of cortisol and prolactin were studied in twenty-one (21) subjects with mean age of 23 + 2 years by obtaining blood sample from each subject, pre-and post-TENS therapy on the first day of menstruation. Visual Analogue Scale (VAS) was used to assess the pre-and post-treatment pain intensity. The TENS unit was applied for a duration of 30 minutes. Results: The paired t-test showed that there was an overall reduction in the mean cortisol and prolactin from pre treatment values of 28.45µg/dl±5.27 and 56.81ng/ml±31.86 to post treatment values of 27.33µg/dl±5.13 and 53.23ng/ml±37.63 respectively. However these differences were not statistically significant (P>0.05). Pain intensity was significantly reduced comparing pre and post treatment VAS scores. Conclusion: The probable mechanism by which TENS effects alteration in cortisol and prolactin levels and pain reduction in PD might be through the opioid-modulating analgesia system, which releases B-endorphins and other endogenous opiates in response to pain. This is because there is close relationship between B-endorphin, cortisol and neurons, which secrete dopamine into the hypothalamic-pituitary-portal system. However this study gives further evidence that women with PD have disturbed hormonal profiles. KEY WORDS: Primary dysmenorrhoea, TENS, Cortisol, Prolactin.
Gender Differences in Cardiovascular Response to Upper Extremities Isometric Exercises in Normotensive Subjects
Background and objective: Studies on gender differences in cardiovascular responses to isometric exercise have been numerous and conflicting. The objective of this study was to determine if the cardiovascular responses to upper extremities isometric exercises differ between apparently healthy male end female subjects. Methods: One hundred and sixty apparently healthy adults with the mean age of 39.0 ± 11.04 years were consecutively recruited into the study. This consisted of 80 males (39.0 ± 10.82 years) and 80 females (38.96 ± 11.25). Data were obtained on participants' age, height, weight, body mass index, blood pressure, heart rate, and Rate Pressure Product. Data were summarized using descriptive statistics of mean and standard deviation. Independent t-test was used to compare physical characteristics between genders while repeated measure of ANOVA was used to compare the pre and post isometric exercises cardiovascular parameters between genders. Level of significance for all tests was set at p< 0.05. Results: The baseline cardiovascular parameters were not significantly different (p> 0.05) between the male and the female participants. The post exercise cardiovascular parameters were significantly greater (p< 0.05) than the baseline values without gender bias. However, the post exercise SBP and RPP were significantly different (p< 0.05) between the male and the female participants respectively. Conclusion: Isometric exercises of the upper limbs can lead to a significant increase in cardiovascular parameters among apparently healthy male and female subjects. Higher ventricular contraction is evoked among males leading increased SBP while the myocardial oxygen uptake and the measure of the oxygen consumption of the heart muscles of the female participants in response to upper extremities isometric exercises is higher than that of the males as demonstrated by the RPP. Key words: Isometric exercises, cardiovascular response, upper extremities exercises.
The Incidence of Agenesis of Palmaris Longus among the Yoruba Tribe in Nigeria
Background: Problem Based leammg (PBL) is increasingly becoming popular worldwide. The Department ofAnatomy at the College of Medicine University of Lagos recently introduced the problem based learning approach as the style of teaching physiotherapy students in their basic medical science year. Objective: This survey investigated the students' view of the programme, its impact on their learning as well as constraining factors. Methods: A questionnaire-based survey was conducted at the end of the basic science academic year. The sample was the whole of a group of physiotherapy student that went through the PBL programme of the Department for one year. Results were collated and data processed using computer Microsoft excel in windows office 2003 software. Results: Astatistically significantproportion ofthe group rated the programme favorably and indicated it was of benefit to their learning experience. Identified areas oftheir learning positively impacted on include; increase in amount of knowledge (81 %), better levels of interaction among colleagues (69%), improved literary research and problem solving skills (72%), higher level of confidence (81 %) and an increased eagerness for clinical school (95%). Conclusion: Problem Based Learning programme can be beneficial to pioneer physiotherapy students in basic medical science year even when it is administered newly by a Department that is still developing in the programme. Key Words: Problem Based Learning, Physiotherapy Students, Anatomy.
Comparative Effects of Transcutaneous Electrical Nerve Stimulation, Cryotherapy and Placebo on Pain, Swelling and Trismus Following Third Molar Tooth Extraction
Background & Objective: This study compared the therapeutic effects of Transcutaneous Electrical Nerve Stimulation (TENS), Cryotherapy and Placebo on pain, swelling and trismus following surgical extraction of the third molar tooth. Methods: Eighteen (18) patients who underwent surgical extraction of the impacted tooth were randomly assigned into three groups- TENS, Cryotherapy and Placebo. Following the surgery, a standard form of TENS was applied over the painful area of cheek for TENS group, Ice was applied directly over the painful area for Cryotherapy group. The TENS machine was detuned while electrodes were applied on the painful sides of the cheek for Placebo group. The pre-operative, pre and post physiotherapy treatment pain ratings, swelling and mouth opening were monitored in each group and the results were compared. Data were analyzed with ANOVA, Turkey's Post-Hoc and t-tests. Level of significance used was 0.05. Results: There was significant reduction in pain in all the groups. TENS and Cryotherapy were more effective in pain modulation than Placebo treatment. Significant reduction in trismus was also demonstrated in the TENS and Cryotherapy over the placebo group (P<0.05). Apart from the placebo treatment, the result did not show significant changes (p>0.05) in swelling resolution. Conclusion: TENS and Cryotherapy were more effective than Placebo treatment in pain modulation and relief of trismus following dental surgery. Therefore the choice between TENS and Cryotherapy should be based on larger number of patients are suggested to evaluate the effect on swelling resolution.
Comparison of Blood Pressure In Deaf Secondary School Children and Their hearing Counterparts: Association Between Noise and Blood Pressure
Background and Objective: High blood pressure has been known to be one of the problems that could develop as a result of exposure to noise. Consequently, those who are hearing impaired are thought to be immune to this. This study assessed the relationship between noise exposure and blood pressure. Methodology: This is a comparative prospective study involving participants (consisting of the hearing and the hearing impaired) drawn from a school environment that is situated close to a major highway and railway and evaluating the impact of noise on their blood pressure. Results: The study population consisted of 299 secondary school students. The noise sensitive group comprised 220 participants with normal hearing while the noise-insensitive group comprised 79 hearing impaired from the same school. More participants 6 (85.7%) from the noise insensitive group were found to have significantly higher blood pressure than their hearing counterparts 1 (14.3%). In addition, majority of the participants (63.1%) irrespective of their level of noise sensitivity were underweight. Conclusion: This study finds noise exposure alone not sufficient to bring about an increase in blood pressure of the studied population. This not withstanding we advocate for policy measures aimed at controlling the source of environmental noise around educational institution which will aid in reducing the adverse effects of noise on the school children. KEYWORDS: Blood pressure, Hearing impairment, Body Mass Index, School Pupils.
Comparative Efficacy of Low level Laser Therapy And Pulsed Ultrasound in the Management of Second - Degree Contusion
Low level LASER therapy (LLLT) and pulsed ultrasound have been shown to relieve pain, promote healing and tissue repair in sport injuries. The objective of this study was to investigate the comparative efficacy of LLLT and pulsed ultrasound in the management of second - degree contusion in sportsmen. This is a 2 group pre-test – post-test quasi – experimental study involving 20 sportsmen, ten were in Group A (LLLT) and ten in Group B (P-US). They were aged between 19 and 30 years with the mean age 24.9 ± 3.28 years and 27.4 ± 3.75 years for the Group A and Group B respectively. Treatment consisted of six sessions, in a period of 2 weeks. Data collected on each participants included age, weight, height, site of injury, pain intensity, swelling, calf girth and range of motion. The result of the study revealed decrease in pain for both LLLT and pulsed ultrasound (p<0.05). There was more significant reduction in pain at the end of the 2 weeks than the 1st week for both modalities. Both modalities did not produce significant improvement in ROM or swelling over the two weeks period (P>0.05). It was concluded that both therapies are equally effective in the management of pain resulting from second – degree contusion in sportsmen. KEYWORDS: Low level LASER, pulsed ultrasound, second – degree contusions.
Relationship Between Spinal Mobility, Physical Performance, Pain Intensity and Functional Disability In Patients With Chronic Low Back Pain
Background: Physiotherapy clinical assessment has traditionally relied on clinical tests of impairment. These tests correlate poorly with patients’ pain and dysfunction, especially in the case of chronic pain. This study was designed to investigate the correlation between some of these tests in patients with chronic low back pain. Methodology: Twenty-three patients (16 males, 7 females) with chronic low back pain participated in the study. Roland- Morris Disability Questionnaire (R-MDQ), Visual Analogue Scale (VAS) and Physical Performance Battery (PPB) were used to collect data. The spinal range of motion was assessed using a tape measure and a goniometer. Data analysis was done using Pearson Moment Product correlation coefficient and Spearman’s Rank. Results: Statistical analysis showed that there was a significant inverse correlation between repeated trunk flexion and anterior trunk flexion (r = -0.488, p<0.05), extension and 50-foot walk (r = -0.462; p<0.05). There was also a significant correlation between functional disability and 50-foot walk (r = 0.456 p<0.05) among all subjects. Conclusion: Increase in pain may not necessarily result in increase in functional disability, as relevant improvements in pain may lead to almost unnoticeable change in disability clinically. Therefore, self-report of disability by patients may not be adequate in making clinical judgement of their condition without the objective assessment of their physical performance. KEYWORDS: Low back pain, Physical performance, Spinal mobility.
Effect of Dominance On The Isometric Hamstring Muscle Length In Undergraduate Students
Background: The knee is frequently prone to traumatic and degenerative afflictions and hence is a common site of pain requiring physical therapy interventions. During the process of rehabilitation, comparisons are usually made with the contralateral knee vis-Ã -vis the knee muscle torques as a criterion reference. In order to validate this practice, is necessary to determine to what extent a pre-injury difference exists between the limbs of otherwise normal subjects. Objective: The purpose of this study was to provide isometric strength data of hamstring muscles in healthy subject and to investigate the effect of dominance on it. Method: Eighty normal male undergraduate subjects with mean age of 23.5 ± 2.14years (range 20-29) were exposed to isometric muscular strength measurement of the hamstring muscles. The thigh muscle bulk, limb length and leg length were also measured. Results: The result showed that dominance has effect on the isometric muscular strength of the lower limb when classified as dominant or non-dominant, strong or weak and right or left. There was also significant effect of dominance on muscle bulk. Significant correlation was found between muscle strength, muscle bulk and body weight. No correlation was found between muscle strength and leg length. Age has no effect on the strength. Conclusion: This study suggests that in gross comparisons only, pre-injury significance exists between contralateral limbs. KEYWORDS: Isometric hamstring muscle strength, dominance leg, leg length, muscle bulk.
Perception of Low Vision Students In Saudi Arabia Regarding Their Integration Into Regular Schools
Background: Low Vision, also referred to as “partial sightâ€, has been defined as “reduced central acuity or visual field loss which even with best optical correction still results in visual impairment from a performance standpoint. Low vision affects many aspects of life, the main goal in the field of low care therefore, is to assist the low vision patient in making the best use of remaining vision for a reasonable quality of life. Education of students with low vision has become a central focus of concern in special education in different countries such as Saudi Arabia. Student with visual impairments have received educational services in a variety of settings including schools for blind or in segregated classrooms in a public school building. Objective: The aim of this study was to investigate the subjective response of Saudi Arabia low vision students towards their integration into regular schools. Methods: Twenty-nine (29) low vision students who study in three regular schools participated in this study. The average age was 13.2 years. They have not used any Low Vision Aids either when they study in blind schools or after they have been integrated into regular schools. A questionnaire was used to measure the subjective response of the student towards the integration in comparison with segregation (School for the Blind). Results: The result of the questionnaire shows that 75.86% of normally sighted students deal friendly with low vision students. Also, it has been found that 79.31% of the visually impaired students were happy to be in regular schools; however, 3.45% was unhappy. Moreover, it has been found that 86.2% of them support the concept of integration in comparison with segregation. In other words, they are not supporting isolation in terms of education. Conclusion: It can be concluded from the study that the integration of low vision students in the regular schools can be very effective and play an important role in improving the quality of education provided to them. KEY WORDS: Integration, Segregation, Low Vision students, Regular Schools.
Musculoskeletal Complications And General Health Status Of Individuals With Sickle Cell Disease
Sickle cell disease is a chronic disease that is associated with high degree of morbidity and mortality. The objective of this study was to find the relationship between musculoskeletal complications and general health status of patients with sickle cell disorders. The HSQ 2.0 questionnaire, (a general health survey questionnaire), was used to assess the subjects’ health status while a separate questionnaire was used to compile data on complications. Descriptive and inferential statistic of Spearman’s correlation was used to find relationship between complications and health status. Level of significance was set at 0.05 alpha. Seventy-two subjects with sickle cell disorder participated in the study. Fifty-six (77.8%) were of genotype Hb SS. Most of the subjects, 51 (70.8%) normally experienced back pain, 22 (30.5%) had chest pain while only 2.8% had visual problem. Generally, subjects scored low on all health status sub-scales except the mental health sub-scale where the mean score was near 60% (59.84 ± 17.41%). The lowest mean score (47.99 ± 24.03%) was obtained on role limitation due to physical health sub-scale. There were significant correlations between complications and health status. It was concluded that the health of individuals with sickle cell disease is compromised on all the eight domains of health status and that painful complications affect their social and physical functioning and impose limitation on them. It was also concluded that the more the number of body parts with pain the lower the health status become. KEYWORDS: Musculoskeletal complications; Health status; Sickle cell disease.
Stress And Strain At The Lateral Collateral Ligament Complex Of The Elbow Joint
Background: The radial collateral ligament was previously believed to be the only ligament existing at the lateral aspect of the elbow joint until Morrey and An (1976) classified the ligaments to include radial collateral (RCL) and lateral ulnar collateral ligaments (LUCL). There is therefore the need to assess the impact these ligaments in elbow joint stability. Objective: To investigate how the RCL and LUCL are affected by stress and strain in both routine and forceful movements of the limb. Materials and Methods: Eight (8) embalmed upper extremities were used for this investigation. The elbow joint was dissected with care taken to preserve the lateral ulnar collateral ligament seen in seven of the limbs. Qualitative assessment of ligament tension was made under valgus and varus stresses. The angles at which stress was applied were 450, 700, 750, 900, 1100, 1200 and full extension. These angles were chosen partly because most movements during racket sporting activities take place at higher angles (Regan et al 1991). The angles were determined by hand held goniometer while the arm was firmly held in a retort stand. Results: The RCL is more able to absorb stress and strain because of its greater flexibility enhanced by its attachment at the annular ligament. However, LUCL a thickened mass, in both valgus and varus stresses was taut throughout most of the entire arc of flexion. It is a much stronger ligament that effectively stabilizes elbow joint in both routine and forceful movement. Conclusion: This study has been able to establish that LUCL is more prone to stress and strain. Being attached from bone to bone, it equally provides greater stability at the lateral aspect of elbow joint. KEY WORDS: Elbow joint; Ulna and Radial Collateral Ligament; stress and strain.
Cardiovascular Responses Of Type 2 Diabetes Patients To Intermittent And Continous Aerobic Exercises
Background: The use of aerobic exercise as a form of glycemic control in type 2 diabetes mellitus has been well documented in the literatures. High blood pressure has been shown to be one of the sequelae of type 2 diabetes mellitus. Determination of mode of exercises for glycemic control that will not adversely affect the cardiovascular indices of type 2 diabetes mellitus subjects is highly indicated. Objective: The purpose of this study was to determine the acute cardiovascular responses of type 2 diabetes mellitus subjects to continuous and intermittent modes of exercises. Results: There was statistical significant difference in heart rate of both groups. Continuous mode of exercise elicited no statistical difference in SBP and DBP but there was statistical significant difference in SBP in intermittent exercise group with no statistical significant in their DBP. Cross comparison of pre and post cardiovascular indices showed that there were statistical significant differences in SBP (F=0.710, P>0.05) and DBP (F=1.397, P>0.05). Conclusion: Cardiovascular responses of type 2 diabetes mellitus subjects were higher in intermittent exercise group compared with the continuous exercise group. KEYWORDS: Type 2 diabetes mellitus, Aerobic exercise, cardiovascular response.
Evidence-Based Practice: Challenges to Medical Rehabilitation Practitioners
Relationship Between Cardiorespiratory Fitness Blood Pressure of Nigerian
Background: Knowledge about the relationship between cardiorespiratory fitness and health outcome is important, because such information adds essential information to the aggregated data that serve as the basis for physical activity guidelines. Objective: The purpose of this study was to evaluate relationship between cardiorespiratory fitness and blood pressure in normotensive individual. Methods: A cross-sectional survey of secondary school students in Sagamu local government area of Ogun state, Nigeria during 2006 school year was carried out. In all 1638 (790 male and 848 female) apparently healthy students with age ranged between 12 and 18 years were selected from 11 schools (8 public and 3 private). The Cardiorespiratory fitness (CRF) and blood pressure of the subjects were measured. Results: A significant negative correlation between CRF and blood pressure (systolic and diastolic) was observed. There was significant curvilinear graded relation between CRF and blood pressure. Coefficient of determination (R2) for cardiorespiratory fitness was 1.54% and 1.18% for systolic and diastolic blood pressure respectively. Conclusion: The greatest benefit may be achieved when increasing the fitness from low to moderate cardiorespiratory fitness. It is therefore important to direct action towards those adolescents who are the least physically fit to increase their cardiorespiratory fitness and hence reduced their blood pressure. Key words: Cardiorespiratory fitness index, blood pressure, CHD
Test-Retest Reliability of Ultrasound Imaging of Lumbar Multifidus Muscle
Background to the study: Muscle strength and muscle size measurement are useful indicator of musculoskeletal pathology but it seems difficult at the moment to isolate individual paravertebral muscle for strength testing. It may therefore be useful to measure muscle size which can be achieved in vivo using diagnostic imaging technique. Purpose of the study: The purpose of this study is to demonstrate test-retest reliability of using diagnostic ultrasound imaging in the assessment of multifidus cross sectional area (CSA). Materials and method: Five apparently healthy volunteers (2 males 3 females) whose ages ranged from 23 to 35 years participated in this study. FF Sonic UF-750XT diagnostic ultrasound imaging machine with a 5MHz curvilinear transducer was used for ultrasound imaging oflumbar multifidus muscle. Results: The results shows that the average scores of lumbar multifidus ranged from 5.3cm2 to 8.6cm2. The test retest reliability for measuring lumbar multifidus on both single (0.996) and average measures (0.999) was good (P< 0.05). Conclusion: Ultrasound imaging could be said to be a reliable method that could be used by physiotherapist in evaluating multifidus muscle size which in turn could be a useful guide to the assessment of the effects of low back pain (LBP) and in the evaluation of the efficacy of common therapeutic intervention for LBP disorders. KEY WORDS: Multifidus, Reliability, Ultrasound Imaging
Association Between Pulse Index and Metabolic syndrome in Individuals with Type 2 Diabetes Mellitus: Outcome of a Twelve-Weeks Therapeutic Exercise
Background and Objective: Metabolic syndrome (MS) is an entity with clustering of cardiovascular risk factors and is associated with Type 2 Diabetes Mellitus (T2DM). Low level cardiovascular fitness is also associated with risk of T2DM. An association between Pulse Index (PI) and MS requires further description. This study sought to determine the association between PI and components of MS. Methods: Seventy-seven participants/subjects aged 48.6±6.52 years with T2DM were enrolled into the study at Aminu-Kano Teaching Hospital, Kano, Nigeria. PI and components of MS including Fasting Blood Glucose (FBG), Glycosylated Haemoglobin (HBAlc), High-Density Lipoprotein (HDL-CHOL), Triglycerides (TRIG.), Blood Pressure (BP) and obesity were assessed before and after twelve-week therapeutic exercises. Results: Inverse correlations were obtained for PI and each ofFBG (r=-0.45), HBAlc (r=-0.52), TRIG (r=-0.26), BP(r=-0.43/-0.32), Waist Circumference (r=-0.53), BMI (r=-0.79), blood pressure (r=-0.43/-0.32) except HDL-CHOL (r= 0.67), (P< 0.05 for all the subjects/participants). Conclusions: Low-levels of PI were associated with poor glycaemia, hypertension, obesity and dyslipidaemia. Therapeutic exercises aimed at improving cardiovascular fitness may have significant improvement on MS. which in turn aids the prevention of both T2DM and cardiovascular diseases. Keywords: Type 2 Diabetes Mellitus, Cardiovascular fitness, aerobic exercises, Pulse Index'
Effect of Percussion and Postural Drainage Positions on Cardiovascular and Respiratory Parameters
Background of the study: There are different drainage positions for different lobes of the lungs but most studies on the effect of postural drainage and percussion on cardiovascular and cardiorespiratory are old and also inconclusive. Aims: The primary aim of this study was to determine the effect of postural drainage positions and percussion in prone lying with foot of bed raised to 45cm and right side lying with 45 degree turn on to the face on cardiovascular and cardiorespiratory parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (RR) and respiratory rate (RR). Method: Forty subjects (20 males and females each) participated in the study and they were randomly assigned to 4 groups with 10 participants in each group. The cardiovascular and cardiorespiratory parameters were measured at sitting (pre-positioning), mid and postpositioning after 15 minutes. The data was analysed using descriptive and inferential statistic. Results: The results showed that percussion significantly decreased the systolic blood pressure (F = 3.15; P < 0.05) while the respiratory rate was increased significantly (F= 5.40; p < 0.05) when the subjects were in prone lying position. The result also showed that the systolic blood pressure and the respiratory rate increased significantly (F=I.26; p < 0.05) and (F=7.18; p<0.05) respectively when the subjects changed from sitting to prone lying positions. Conclusion: This result showed that some postural drainage positions and percussion affects the systolic blood pressure and the respiratory rate KEY WORDS: Postural drainage, Percussion, Blood pressure, Respiratory rate
The Prevalence of Low Back Pain in Commercial Motor Drivers and Private Automobile Drivers
Background: The low back is susceptible to injury (pain) because it supports most of the body weight. Prolonged sitting and being sedentary are some of the risk factors to developing low back pain (LBP). This study was designed to determine and compare the prevalence of LBP in Commercial Motor Drivers (CMD) and Private Automobile Drivers (PAD). Materials and Method: Five hundred males (250-CMD and 250-PAD) participated in the survey. The participants were made to complete a 33-item closed ended questionnaire. The questionnaire collected information on the respondents' biodata, driving, back pain and the effects of driving on the low back (LB). The questionnaire was selfadministered. Results: The results showed that LBP was a major problem among these groups ofdrivers. The 12-month prevalences of LBP among the CMD and PAD were 96% and 88% respectively. Twelve-month prevalence of LBP was significantly (p< 0.05) higher in the CMD. Sixty four percent and 42% of the CMD and PAD attributed the cause of their back pain to the length of time spent sitting when driving. Conclusion: Low back pain was a major problem among the respondents; but was experienced more among CMD. The higher prevalence of LBP in CMD was attributed to the length of time spent sitting when driving. KEY WORDS: Prevalence, low back pain, Commercial Motor Drivers, Private Automobile Drivers.
Job Evaluation of Clinical Physiotherapists in the South West of Nigeria
Background ofthe study: Resourcefulness is the quality of being able to cope with a difficult situation and have imaginative abilities while service development processes allow the building and testing of services and related component. The involvement of physiotherapists in supervision, administration, teaching and research in health sciences is yet to be ascertained. Aims: The primary purpose of this study was to evaluate level of involvement of clinical physiotherapists in administration, teaching, research and policy formulation, human resources and information technology. Method: One hundred (100) copies of self-administered questionnaire adopted from National Health services job evaluation questionnaire were administered to physiotherapists in selected Federal and State Hospitals. The response rate was 71 %. The data was analysed using descriptive Statistic. Results: The result showed that 97.2%,84.5%,76.6% and 58.5% of clinicians were resourceful in effective patient communication, analytical skill, patient care and freedom of action respectively. Also 10% carried out research regularly and 35.2% carried it out occasionally. About 47.9% and 80.3% were resourceful in human resources management and policy formulation respectively for physiotherapists in the chief cadre. The assistant Chief Physiotherapists were found to be more resourceful than the Chief Physiotherapists in the area of resource management. The study further showed that only 17.4% of the physiotherapists were involved in utilizing information technology. Conclusion: This study concluded that clinicians are not highly resourceful especially in the areas of human resources, policy and research, and information technology but were involved in effective communication, judgment and analytical skills, patient care and have freedom of actions. KEY WORDS: Resourcefulness, Administration, Physiotherapy, Policy
The Spinal Column and Abdominal Pressure changes and their relationship with Pain severity in Patients with Low Back Pain
Background: Low back pain (LBP) is a complex condition which is mainly associated with back (multifidi) and abdominal (transverses abdominis) muscles dysfunction. Though pain is one of the indicators of LBP, the literature data regarding relationship between pain and muscle dysfunction is lacking. Objective: The objective of this study is to investigate the differences in spinal column pressure changes (SCPC) and abdominal pressure changes (APC) in male and female patients with LBP and evaluate their relationship with pain severity. Methods: Thirty nine patients (28 male and 11 female) with sub-acute or chronic LBP participated in the study. Spinal and abdominal muscles pressure changes were measured by pressure measuring device (PMD) while pain severity (Pain) was assessed by Visual Analogue Scale (VAS). Eight physical characteristics such as Age, Weight, Height, waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse rate (PR) were also taken while waist hip ratio (WHR) and body mass index (BMI) were estimated from WC and HC and Weight and Height respectively. Statistical analysis was done using independent Student's t-test, Spearman rank correlation and step wise multiple regression analysis. Results: The mean Age, Weight, WC, HC, WHR, SBP, DBP, DUR and Pain ofmale and female were found to be similar (p> 0.05). The mean level of both SCPC and APC in male and female differed significantly (p< 0.01) and the levels ofboth were significantly (p< 0.05) high in male than female and for this, significant (p< 0.05) differences in Height, BMI and PR were found to be the responsible. Both spinal column and abdominal pressure changes showed inverse and significant (p< 0.01) correlation with the Pain severity. The WC (waist circumference), HC (hip circumference), BMI and PR were found to be significant risk factors for LBP as they correlate positively and significantly (p< 0.01) with the pain severity. Pain and DUR (duration of pain) were found to be significant predictors of SCPC which accounts for 73% variations of SCPC while Pain, Height and WC of APC which accounts for 61% variations of APC. Conclusion: In LBP, spinal column and abdominal pressure changes have inverse and significant (p< 0.01) relation with the pain severity. Though, most of the physical characteristics ofmale and female were similar, their spinal and abdominal pressure changes differed significantly. The findings of this study may be helpful in the management of LBP and it is recommended that clinicians should adopt both the pressure changes for diagnostics and prognostics of LBP.
An Assessment of Erognomic Work Stations and Pain among Computer Users in a Nigerian University Community
Background and Objective: Computer usage is a trend in technology advancement that is common with virtually all jobs and it predisposes all users to avoidable musculoskeletal injuries. This study aimed at determining Computer Workstation (CW) ergonomics among computer users in ObafemiAwolowo University Ile-Ife, Nigeria. Also the distributions of musculoskeletal pain experienced by computers users were determined. Methods: One hundred and fifty (150) participants were recruited using cluster sampling technique. Participants must have been users for 6 months, working l5hours per week .The participant's bio-data were recorded and CW were identified and measured for footrest, casters, keyboard height, seat height, monitor height, seat back angle and arm angle. They were asked if they were experiencing pain, its location and cause. Data were analysed using descriptive statistics. Results: Results obtained showed that 23 (15.3%) ofthe CW had 5 casters, and just 3 (2%) had footrests while there were, 130 (86.7%) and 104 (69.3%) with ideal chair and keyboard heights respectively. Also, there were 130 (86.7%) and 136 (90%) with ideal monitor height and seat back angle respectively. Results showed that 105 (70%) of the participants experienced pain and mostly (52.4 % of the 70%) in the back with mean pain intensity 7 on a 10 point pain scale. Participants; (38) 25.3%, believed that CW arrangement was the cause of the pain. Conclusion: This study concluded that majority of the CW did not meet the standard description of CW and majority ofthe computer had pain in the low back as at the time of study. Keywords: Ergonomic workstation, Computer users, Musculoskeletal Pain, Nigerian University