<p>Osteonecrosis of hip or Avascular necrosis (AVN) of hip, is the vascular disruption of the hip joint lead to the death of the femoral head. AVN is more common in males than in females. Most Commonly clinically presents as the insidious onset of pain around the hip and restricted range of motion of hip Join that lead to patients have a problem in wait bearing and during walking. Patients cannot walk properly.</p><p>Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. D-dimer elevation is often observed in patients with acute COVID-19 due acute lung injury itself or due thromboembolic complications that occur frequently in COVID-19. Thromboembolism can damaged nearby blood vessels and reduce blood flow to bones lead to AVN can developed. Those who are suffering from Mild to Moderate COVID-19 they take more amount of corticosteroids during the acute phase of infection. Use of high-dose corticosteroids, such as prednisone can increase lipid levels in the blood, reducing blood flow. Due to Increase Lipid Levels and more Thromboembolism the cases of AVN Hip is increasing day by day.</p><p>Physiotherapy Can be used for relief of symptoms of Pain and Restricted ROM of hip joint. It can be help to prevent of disease progression and Improvement of functional activity and ADL. Physical therapy treatment focuses on exercises to maintain joint mobility and strengthen the muscles around the affected hip joint. Exercises will focus on the muscles of the hip and thigh but will also include exercises for the core area as they play a large supporting role. To improve functionality, it is important to implement endurance training and coordination training in a more advanced stage of the therapy.</p>

<p>Low back pain is defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain. This profoundly affects daily activities and frequently impairs functional tasks. Low back pain (LBP) affects nearly 60-80% of people throughout their lifetime.One of the suspected etiologies of LBP is lack of hamstring flexibility. Sitting at a desk all day can cause tightness and a shortening of hamstring muscles, and therefore leads to back pain.</p><p>The hamstring group refers to the posterior thigh muscles and act as strong flexors of the knee and weak extensors of the hip.</p><p>Hamstring group of muscles includes <strong>semitendinosus</strong>, <strong>semimembranosus</strong>, and <strong>long and short heads</strong> of the <strong>biceps femoris</strong>. All together flex the knee but the short head of biceps femoris alone extends the hip.Blood supply from the perforating branches of the deep femoral artery ,also known as the profunda femoris artery.</p><p>We might be wondering how hamstring tightness could result in back pain. The body is interconnected, and prolonged sitting without stretching can cause the hamstrings to constrict and shorten. These muscles originate from the ischial tuberosity of the pelvis . The pelvis tilts posteriorly as a result of tight hamstrings As the pelvis and the lumbar vertebrae work together, when the pelvis tilts posteriorly, the lumbar vertebrae are forced to flex forward. The pelvis, lumbar spine, and surrounding muscles are put under more tension and strain as a result of this. Blood supply to the hamstrings will be reduced if they are tight. Therefore, muscles are working with less capacity, which results in low back pain.</p><p>The predominance of tightness is greater in female 96% than in male 4%. Its incidence is high in university students from 18-25 years.</p><p><strong>Stretch to reduce the pain .The stretches can gradually lengthen and reduce tension in the hamstring muscle, and in turn reduce stress felt in the lower back.</strong></p>

<h3>INTRODUCTION: -</h3><p>The slump test is a provocative test that produce maximal stress on the dura matter at spinal cord. It is covered under a neural tension test used to detect altered neuro-dynamic and neural tissue sensitivity in the patients with suspected disc protrusion. According to cyriax, this test determines the relationship between the patient’s symptoms and restriction of movement due to pain sensitive structures within the vertebral canal or intervertebral foramina. A very popular straight leg raise test is usually preferred by every physiotherapist to differentiate the causes of lower back pain, but SLR on its own is not sufficient to reveal canal and foraminal component. So, by using the slump test canal and foraminal structures are put on maximal stretch to evolve its involvement. Description and technique of performance might change among different sources but the aim of the test is the reproduction or provocation of pain which is common in every literature.</p><h3>TEST POSITION: - <span>Sitting</span></h3><p>DESCRIPTION OF THE TEST: -</p><p><ol><li><p>STEP 1: - SYMPTOMS IN THE ERECT POSTURE</p><ul><li><p>Patient sits erect, cervical- thoracic and lumbar spine should be in erect position.</p></li><li><p>No slouch / curved spine allowed.</p></li><li><p>Symptoms are defined in this position.</p></li></ul></li><li><p>STEP 2: - SYMPTOMS AND RANGE IN SLUMPED THORACIC AND LUMBAR AREAS</p><ul><li><p>Patient slumps and therapist assist the patient to full flexion of the thoracic and lumbar spines, preventing flexion of spine.</p></li><li><p>The symptom reproduction to the slumped thoracic and lumbar areas are noted.</p></li></ul></li><li><p>STEP 3: - SYMPTOMS AND RANGE IN SLUMPED CERVICAL, THORACIC AND LUMBAR AREAS</p><ul><li><p>In addition to slumped lumbar and thoracic areas, therapist adds cervical spine full flexion and notice the symptoms.</p></li></ul></li><li><p>STEP 4: - SYMPTOMS AND RANGE IN FULLY SLUMPED SPINE WITH KNEE EXTENSION</p><ul><li><p>Therapist adds and assist the patient to extend knee joint and determine the response of patient.</p></li></ul></li><li><p>STEP 5: - SYMPTOMS AND RANGE IN SLUMPED POSITION WITH KNEE EXTENSION AND ANKLE DORSIFLEXION</p></li><li><p>STEP 6: - SYMPTOMS AND RANGE CHANGES WITH RELEASE OF CERVICAL SPINE FLEXION</p><ul><li><p>While the patient is held in the position of maximum stretch (i.e. complete spine in full flexion with knee extension and ankle dorsiflexion) therapist release the cervical spine from flexion and note the change in symptoms.</p></li><li><p>In the patients with spontaneous onset pain the response will be release of pain with release of cervical spine release.</p></li></ul></li><li><p>STEP 7: - SLUMP TEST WITH EXTENSION OF BOTH KNEES AND DORSIFLEXION OF BOTH ANKLES</p></li></ol></p><h3>DIAGNOSTIC ACCURACY FOR LUMBAR DISC HERNIATION</h3><ul><li><span>SENSITIVITY: - 84</span></li><li><span>SPECIFICITY: - 83</span></li></ul><h3 class="mt-2">RATIONALE</h3><p>The test’s result can be interpreted in many ways. While complete flexion of spine and hip with extended lower extremity, the sciatic nerve along with respective nerve roots are put on tension to detect the potential disc herniation and stress on the nerve.</p><h3 class="mt-2">INTERPRETATION OF TEST</h3><p><ul><li><span>Positive test is when pain is reproduced with neural symptoms.</span></li><li><span>Negative test is when pain is not reproduced and no neural symptoms appear.</span></li></ul></p>

<p>Soccer is a physically demanding sport that requires players to be in excellent physical condition to perform at their best. However, the risk of injuries is always present due to the high-intensity nature of the game. To address this issue, FIFA developed the FIFA 11+ injury prevention program, aimed at reducing the risk of injuries among soccer players of all levels.</p><p>The FIFA 11+ program consists of a series of exercises designed to improve strength, balance, agility, and flexibility while also targeting key risk factors for injuries, such as incorrect movement patterns and muscle imbalances. By incorporating these exercises into their regular training routine, players can significantly reduce their chances of sustaining common injuries like muscle strains, ligament tears, and sprains.</p><p>The FIFA 11+ program emphasizes dynamic stretching and muscle activation exercises to prepare the body for soccer matches, increasing flexibility, improving proprioception, and reducing injury risk.</p><p>In addition to the physical benefits, the FIFA 11+ program also emphasizes the importance of good technique and proper body mechanics to prevent injuries. By teaching players how to move efficiently and safely on the field, the program helps reduce the risk of overuse injuries and repetitive strain.</p><p>Overall, the FIFA 11+ injury prevention program is effective in reducing the incidence of injuries among soccer players. By incorporating this program into their training regimen, players can improve their performance on the field while also safeguarding against the physical toll that the sport can take on their bodies. Whether you&#39;re a professional athlete or a casual player, following the FIFA 11+ program can help keep you healthy, strong, and injury-free while playing the beautiful game of soccer.</p>

<p>As people age, their immune systems vary significantly, resulting in differences in how older men and women respond to flu vaccines. According to research, elderly men&#39;s and women&#39;s immunological responses to influenza vaccine vary significantly.</p><p>Hormonal differences between men and women have a significant role in these discrepancies. Estrogen, which is found in greater amounts in women, has been demonstrated to improve immunological response to vaccinations, particularly flu injections. According to studies, women may have a stronger immunological response to vaccination than males because of hormonal influences.</p><p>Furthermore, age-related immune system changes, known as immunosenescence, influence how older people respond to immunizations. In general, older persons have a weakened immune system, which leads to a worse response to vaccination. However, research suggests that women may maintain greater immune function as they age than males, perhaps leading to a more effective response to flu vaccines.</p><p>In addition, variations in the way older men and women react to flu vaccines might be attributed to hereditary factors. It is known that individual reactions to vaccination are influenced by differences in genes linked to immune function and vaccine response. Variations in vaccination effectiveness between older men and women have been identified; these discrepancies may be partially explained by genetic differences.</p><p>In summary, whereas vaccinations against influenza protect against the disease for older men and women alike, there are notable variations in the immune responses of these populations. Comprehending these distinctions is crucial for refining vaccination plans for senior citizens and creating specialized methods to increase vaccination efficacy in this demographic.</p>

Volume - 1, Issue - 1

<p>Sarcopenia is a condition characterized by the loss of muscle mass, strength, and functionality that often occurs with aging. This age-related muscle wasting can have significant impacts on an individual's quality of life, leading to decreased mobility, increased risk of falls, and overall reduced ability to perform daily tasks.</p><p>While some muscle loss is a natural part of the aging process, sarcopenia goes beyond the typical decline in muscle mass that occurs with age. It is often associated with factors such as decreased physical activity, poor diet, hormonal changes, and chronic illnesses. Additionally, sarcopenia can be exacerbated by conditions like inflammation, insulin resistance, and oxidative stress. The consequences of sarcopenia can be far-reaching. Loss of muscle mass can lead to a decrease in metabolism, making it more difficult to maintain a healthy weight. It can also impact balance and coordination, increasing the risk of falls and fractures. Furthermore, reduced muscle strength can affect overall mobility and independence, potentially limiting an individual's ability to live an active and fulfilling life.</p><p>Preventing and managing sarcopenia requires a multifaceted approach. Regular physical activity, particularly resistance training, is essential for preserving muscle mass and function. Adequate protein intake is also crucial for supporting muscle maintenance and repair. Additionally, maintaining a healthy weight, managing chronic conditions, and ensuring adequate vitamin D and calcium levels can help mitigate the effects of sarcopenia. Early detection and intervention are crucial for addressing sarcopenia, enabling healthcare providers to assess muscle mass and strength, and implementing targeted interventions like exercise programs.</p><p>Sarcopenia, a significant health concern, can significantly impact physical function and well-being, particularly in older adults. Effective prevention and management can be achieved through a healthy lifestyle and regular exercise.</p>

<p>An exercise routine may feel time consuming — but no matter what type of workout you choose, or how busy your schedule is, it’s critical that you don’t skip warming up before your workout, or cooling down afterwards. You’d be surprised how many people decide they don’t need to warm up before working their core, or that it’s fine to skip their cool-down after jogging on the treadmill.</p><p>In most cases, it’s not because people hate doing the warm up or cool-down, but because they want to save time. Unfortunately, it’s not just the main part of your workout that matters — and the people who skip the processes before and after a workout may be doing more harm to their bodies than they realize.</p><div class='text-center mb-3'><img src='/assets/img/vol-2-issue-2-a2.png' /></div><h3>Why Warming Up and Cooling Down Is So Important</h3><p>A warm-up and a cool-down both involve doing exercises at a lower intensity and slower pace, which improves your athletic performance, prevents injuries, and helps with recovery from exercise.</p><p>Warm up activities include light jogging, or cycling slowly on a bike. Warming up before exercise prepares your cardiovascular system for physical activity, by increasing the blood flow to your muscles, and raising the temperature of your body. It also helps to lower the risk of getting injured — when your muscles are adequately warmed up, the movements, stretches, and strain you put on them during your workout is less severe. This also minimizes muscle soreness.</p><p>Warm up activities include light jogging, or cycling slowly on a bike. Warming up before exercise prepares your cardiovascular system for physical activity, by increasing the blood flow to your muscles, and raising the temperature of your body. It also helps to lower the risk of getting injured — when your muscles are adequately warmed up, the movements, stretches, and strain you put on them during your workout is less severe. This also minimizes muscle soreness.</p><p>Cooling down after your workout aims to gradually bring your heart rate and blood pressure to its normal level — the level it was at prior to exercising. During your workout, your heart rate has been pumping much higher than it does normally, and it’s important to ease it back down instead of abruptly stopping all motion. Cooling down also helps to regulate your blood flow, which is especially important for people who undertake endurance sports such as long distance running. To safely cool down, gradually reduce the pace of your exercise during the last 10 minutes of your session — for example, if you’re jogging, reduce your pace to a brisk walk for the last 10 minutes.</p><h3>Benefits of Warming Up</h3><div><ul><li><p><strong>Improved Performance:</strong> Warming up improves your athletic performance in the following ways:</p></li><li><p><strong>Improved Blood Flow:</strong> Warming up for 10 minutes with an easygoing activity improves blood flowing to your skeletal muscles, and opens up blood capillaries. Your blood carries the oxygen needed for your muscles to function, so increasing your blood flow is one of the best things you can do to set your muscles up for a workout.</p></li><li><p><strong>Improved Oxygen Efficiency:</strong> When you do a warm-up exercise, oxygen is released from your blood more readily, and at higher temperatures. Your muscles demand higher amounts of oxygen while exercising, so it’s important to make this oxygen more available through a warm-up activity.</p></li><li><p><strong>Faster Muscle Contraction/Relaxation:</strong> Warming up with physical activity raises your body temperature, which in turn, improves your nerve transmission and muscle metabolism. The end result? Your muscles will perform faster and more efficiently.</p></li><li><p><strong>Injury Prevention:</strong> Warming up prevents injuries by loosening your joints, and improving blood flow to your muscles — making your muscles less likely to rip, tear, or twist in a harmful way during your workout. Stretching also helps prepare your muscles for the physical activities you’re about to perform.</p></li><li><p><strong>Mental Preparation:</strong> A side benefit of warming up is that your brain will become focused on your body and your physical activity as you go through the process. This focus will carry over into your training session to help you to improve your technique, coordination, and skill.</p></li></ul></div><h3>Benefits of Cooling Down</h3><div><ul><li><p><strong>Recovery:</strong> After intense exercise, lactic acid builds up within your system, and it takes time for your body to clear it out. Cooling down exercises (such as stretches) can aid this process of releasing and removing lactic acid, helping to speed up your body’s recovery post-workout.</p></li><li><p><strong>Reducing DOMS (Delayed Onset Muscle Soreness):</strong> While muscle soreness is to be expected after exercise, a significant amount of DOMS is very uncomfortable, and can prevent you from exercising in the future. A study performed by California State University found that moderate intensity cycling after strength exercise helped to reduce DOMS. Cooling down after exercise helps to alleviate excessive muscle soreness, keeping you more comfortable and allowing your body to bounce back before your next workout.</p></li></ul></div><h3>What Happens If You Don’t Properly Warm Up and Cool Down?</h3><ul><li><p><strong>Increased Risk Of Injury:</strong> Over 30% of injuries seen by sports medicine clinics are skeletal muscle injuries — which can be easily prevented by warming up and stretching.</p></li><li><p><strong>Blood Pooling:</strong> If you stop exercising abruptly without cooling down, your muscles will suddenly stop contracting vigorously. This can cause blood to pool in the lower extremities of your body, leaving your blood without as much pressure to be pumped back to the heart and brain. As a result, you may dizzy and lightheaded, and you may even faint.</p></li><li><p><strong>Increased Stress On Cardiovascular System:</strong> Warming up helps you to gradually increase your heart rate and breathing to a level that will be able to meet the demands of your workout. If you start exercising at a strenuous level without warming up first, you will place unnecessary stress on your heart and lungs.</p><p>The next time you feel like you can’t spare the extra 10 minutes to cool down after running, think carefully about the effect it will have on your body. Those 10 minutes certainly seem worth it when you consider that you’re helping prevent injuries to your body, improve your performance, and aid your post-workout recovery.</p></li></ul>

<h3 class='mb-0'>INTRODUCTION:</h3><hr class='mt-0' /><h4>LOWER CROSSED SYNDROME</h4><p>Lower crossed syndrome (LCS) is a musculoskeletal imbalance characterized by specific patterns of muscle weakness and tightness that crosses between the dorsal and ventral sides of the body. It is also known as a pelvic crossed syndrome. In lower crossed syndrome, the thoraco-lumber extensors are tight in dorsal side and there are also tightness in illiopsoas on the other side. While there are weakness in abdominals muscles and gluteus maximus muscles.</p><p>The result of chain reaction that the pelvis tips forward on the frontal plane, flexing the hip joints and producing lumber lordosis and stress at L5-S1 with pain and irritation. A further stress commonly appears in the sagittal plane in which quadratus lumborum tightness and gluteus maximus weaken.</p><p>When this ‘lateral corset’ becomes unstable, the pelvis is held in increased elevation, accentuated when walking, resulting in L5-S1 stress in the sagittal plane. One result is low-back pain. The combined stresses described produce instability at the lumbodorsal junction, an unstable transition point at best.</p><p>Failure of coactivation due to persistent tonic activity results in faulty neurodevelopment of the motor system. This eventually promoting lower crossed syndromes.</p><h4>FLATFOOT</h4><p>Flatfoot deformity defined by the loss of medial longitudinal arch of the foot where it contacts or nearly contacts the ground. There are two types of flatfoot deformity. The first type is rigid or congenital flatfoot and second type is acquired or flexible flatfoot.</p><p>Flexible flatfoot may result from tibial or femoral torsion, coxa vara, a defect in the subtalar joint, or injury to the posterior tibial tendon.</p><p>The need of the study is to evaluate the incidence low back pain in Physiotherapy students. To evaluate incidence of lower cross syndrome and flat foot in low back pain subjects</p><h4>Design:</h4><p>A total 234 students both girls and boys between age group 18 to 24 years were screened by self administered questionnaire form, from which 82 students having low back pain are taken into consideration. Each student were underwent for assessment of tightness of illopsoas with use of thomas test, tightness of errector spine ( LUMBER FLEXION ROM) with use of modified modified schober’s test , strenght of abdominals and gluteus maximus with use of manual muscle testing, flatffot with using of nevicular drop test.</p><h4 class='m-0'>METHODS:</h4><hr class='mt-0' /><h5>MEASUREMENT OF EERECTOR SPINE THIGHTNESS:</h5><p>Modified Modified schober’s test: Ask the subject to standing postion. Place a first mark at a middline point on the sacrum that is level with the posterior superior illiac spine( this mark will be over the spinous process of S2). Make a second mark 15 cm above the middline sacral mark. Align the tape measure between the superior and inferior marks. Ask the subject to bend forward as far as possible while keeping the knees straight. Maintain the tape measure against the individual’s back during the motion, but allow the tape measure to unwind to accommodate the motion. At the end of flexion ROM, note the distance between the two marks.(1)</p><h5>MEASUREMENT OF ABDOMINAL MUSCLE STRENGTH:</h5><p>The subject were placed in supine lying position with legs straight and fingertips lightly touching the back of the head ( Grade 5 ) , arm crossed over the chest ( Grade 4 ), arms outstretched in full extension above the plane of the body (Grade 3). For Grade 2 ,1 and 0 subject were placed in supine lying position with arm at sides. Knees flexed. Therapist stand at side of the table at level of patient’s chest to ascertain whether scapular clear table during test. Then ask the subject to lift the shoulders, and back off table, keeping the chin pointed to cilling. Patient flexes trunk through range of motion, lifting the trunk until scapulae clear the table. IF the patient has weak hip flexors, therapist should stabilize the pelvis by leaning across the patient on the forearms.(2)</p><h5>MEASUREMENT OF GLUTEUS MAXIMUS STRENGTH:</h5><p>The subject is ask to lie in prone with knee flexed 90 degrees, hip abducted and externally rotated. Therapist stand at leval of the pelvis on the side to be tested. Ask the subject to lift the thigh off the plinth as high as possible, while bending the knee. Place the hand for resistance over the posterior thigh just above the knee. The opposite hand may stabilize or maintain the alignment of the pelvis. Resistance is given in a straight downward direction. According to MRC grading the strength of gluteus maximus was graded.(2)</p><h5>MEASUREMENT OF ILLIOPSOAS MUSCLE TIGHTNESS:</h5><p>Ask the subject to lies supine. The examiner flexes one of the subject’s hips, bringing the knee to chest to flatten out the lumber spine and to stabilize the pelvis. The subject holds the flexed hips against the chest. If the is a no tightness, the hip being tested ( The straight leg) remains on the examining table. If the tightness is present, the subject’s straight leg raises off the table and muscle stretch end feel will be felt. If the lower limb is pushed down onto the table, the subject may exhibit an increased lordosis; again, the result indicate the positive test.(3)</p><h5>MEASUREMENT OF FLATFOOT:</h5><p>Ask the subject to relax sitting position. The examiner first measure the height of the navicular from the floor in the neutral talus position using the most prominant part of the navicular tuberosity and then measure the height of the navicular in normal relaxed standing. The difference is called navicular drop. Any measurement greater than 10 mm is considered abnormal.(3)</p><h5>RESULT:</h5><p>The study concludes that there is 35.04% students of physiotherapy college having low back pain. Out of that 73.17% students having a incidence of lower crossed syndrome and 6.09% students having a incidence of flatfoot.</p><p>The study concludes that there is a 5.98% students of physiotherapy college having low back pain since last one month. Out of that 78.57% students having lower crossed syndrome and 7.14% students having incidence of flatfoot.</p><h5>REFERENCES:</h5><div><ol><li><p>Cynthia C. Norkin, D. Joyce White (Fifth Edition)</p></li><li><p>Daniels and Worthingham's (First South Asia Edition)</p></li><li><p>David J. Magee (Sixth Edition)</p></li></ol></div>

<h3>ABSTRACT:</h3><p>The purpose of this study was to determine the underlying reason for occurrence of stroke in young craftsman and make him achieve his goal of performing activities of daily living independently post stroke. He underwent physiotherapy treatment for seven days while admitted in the ward where the exercises were given on the basis of impairments. The therapy was targeted to achieve his goal to return to his working routine and earn for the living for him as well as his family.</p><h4>Keywords</h4><p>Young stroke, Hemorrhage</p><hr/><h3 class='mt-4'>INTRODUCTION:</h3><p>The occurrence of stroke in young adults comprises of around 10-15% of total stroke in a year worldwide.1 Most of young strokes encountered are ischemic ones whereas very few of them are found to be hemorrhagic. Approximately 30-35% of young stroke cases are accounted to be hemorrhagic (Intracerebral and subarachnoid).2</p><p>Stroke is one of the leading causes of disability, morbidity and mortality in the world. People suffering from stroke have greater impact on family and social life. They are often employed, peaking at their careers, caring for the dependents in the family which is affected due to impairments persisting post stroke. Rehabilitation and recovery process for young stroke survivors differs from those in older adults. It involves restoring the person to his or her functional status before stoke as well as able to return to occupation.</p><p>Most of young stroke cases do not have known and usual etiologies. There many underlying possibilities not understood at time of onset such as developmental cardiac abnormalities, hematological disorders, chronic systemic inflammation and many others.3Many risk factors are also responsible for stroke in young adults such as drug abuse, contraceptive use, and hypertension.</p><p>Young stroke is a major cause of concern in developing countries such as India as they belong to earning strata of the society. This case study aimed at knowing the underlying pathology in a young stroke patient and rehabilitates him to a functional level so that he can join his job.</p><h3>CASE DESCRIPTION:</h3><p>A 26 year old male, craftsman by occupation, presented with history of loss of consciousness followed by regaining it after 2 mins while playing outdoors and was in usual state after that. Around 5 hours after this episode he had a syncope accompanied by involuntary movements and loss of consciousness. He was reported to have seizure episode and was admitted in ICU in local hospital. He underwent emergency intubation was on ventilator for a day and then weaned off.</p><p>He was suggested to shift in tertiary hospital care, where on the way he had a fall in ambulance but sustained no external injuries. After around 3 days, he had sudden onset of severe headache posteriorly and aching in nature, and sudden weakness of right hand and right leg characterized by inability to lift right arm and move right leg. He was immediately shifted to ICU and immediate medical care was taken. MRI investigations were done which revealed minimal Subarachnoid Hemorrhage (SAH) in bilateral parietal regions. He recovered from his weakness after around 7-8 hours after onset of weakness. He was then shifted to ward and referred for physiotherapy treatment.</p><p>The patient did not have any history of hypertension. He reported to have occlusion of varicose veins by thrombus about a year age which was resolved with allopathy medications for month followed by homeopathy medication for around 7 months. He did not report of having any addictions.</p><p>On examination by physiotherapy department, he had intact higher motor functions and speech with retention of memory about the subsequent events that occurred which led to the weakness. On observation he had stoop posture in sitting with protracted shoulders. The cranial nerves and sensation were intact, plantar reflex was up going on right side and deep tendon reflexes were normal (++) bilaterally. Tone was normal but there was some amount of weakness persisting in right lower extremity. Muscles such as hip flexors, abductors, extensors; knee flexors, extensors and dorsiflexors were graded 4 on doing MMT (Manual Muscle Testing) on right side. Balance was affected with fair dynamic balance in standing and good static balance. He could perform transitions such as supine to sit, sit to stand, and walk independently or requiring supervision at times. His baseline measurement of STREAM (Stroke Rehabilitation Assessment of Movement), TIS (Trunk Impairment Scale), Mini-BESTest scales were taken whose values were 56/70, 20/23, 10/28 respectively. He had difficulty in performing activities such as dressing, bathing and toileting activities and required minimal help of bystanders to perform these activities.</p><h3>INTERVENTION:</h3><p>The therapy aimed at strengthening of weak muscles and balance training to help him to achieve independence in performing activities of daily living.</p><p>Muscles such as shoulder flexors, abductors, elbow flexors, hip flexors and abductors, knee flexors and extensors, dorsiflexors were strengthened by attaching 1 kg weight cuff and moving the limbs in required direction. Weight bearing activities such as partial squats, single limb squats (weight bearing on right side) were done with 10 repetitions in 2 sets.</p><p>Balance training involved giving reach outs within base of support and out of base of support in sitting as well as standing. He was made to stand with narrow base of support for 30 seconds initially with eyes closed gradually after 6 days of regular training he could stand for 60 seconds in narrow base of support. Similarly single limb stance initially he could stand only for 15seconds with eyes closed on right leg, progression was made each day, and with training he could maintain balance for 45 seconds after 6 days of training.</p><p>Ambulation- He was made to walk on a straight line on 2nd day of reference, gradually the complexities were increased such as head turns during walking, altering speed while walking, taking turns, answering questions simultaneously (training for dual tasks). These activities were targeted so that while performing regular activities patient did not lose balance.</p><p>On 5th day of training he was trained with stair climbing initially with one step upwards with one leg followed by other leg on the same step with railings support. Progressively he was made to climb stairs with alternate stepping without railings support.</p><p>After 7 days of intervention, scales were again taken to know the amount of improvement with respect to recovery. The STREAM score was 70/70, TIS was 23/23, Mini-BESTest was 21/28 on the day of discharge from hospital.</p><p>He was given advised to avoid addictions, in case of similar episode to have emergency consultation to neurologist and regular compliance with neurologist was suggested as he was at high risk of developing similar episode.</p><h3>RESULTS:</h3><p>After 7 days of physiotherapy treatment the patient could balance while walking, reduced incidences imbalance when distracted while walking. He could perform activities such as dressing, bathing, and toileting independently without supervision of bystanders. He was ready to resume his job within few days and support the family.</p><h3>DISCUSSIONS:</h3><p>Functional prognosis represents one of the most important and meaningful aspects of outcome of disease. The patient almost recovered from the impairments suffered post stroke.</p><p>The patient did not have any history of long standing headache (migraine) indicating internal bleed. There is no history fall or trauma on head causing internal bleed. Symptoms such as severe headache and loss of consciousness in indicative of hemorrhage but pathology causing hemorrhage could not be understood.</p><p>SAH has high chances of neuroinflammation causing early brain injury and delayed brain deterioration including cellular and molecular events.4So it was necessary to make the patient aware of possible consequences such as reoccurrence of stroke.</p><h3>CONCLUSION:</h3><p>The case study reveals that conventional physiotherapy techniques and methods helped the patient achieve his goal of performing activities of daily living independently. The therapist ensured that the patient was counselled about his condition and had chances of further complication and to take appropriate preventive measures.</p><h3 class='mt-4'>REFRENCES:</h3><div><ol><li><p>Smajlović D. Strokes in young adults: epidemiology and prevention. Vascular health and risk management. 2015; 11:157.</p></li><li><p>B. S., Boden-Albala, B., Lin, I. F., & Sacco, R. L. (2002). Stroke in the young in the northern Manhattan stroke study. Stroke, 33(12), 2789-2793.</p></li><li><p>Bevan, H., Sharma, K., & Bradley, W. (1990). Stroke in young adults. Stroke, 21(3), 382-386.</p></li><li><p>Zheng VZ, Wong GK. Neuroinflammation responses after subarachnoid hemorrhage: a review. J Clin Neurosci. 2017 Aug 1; 42:7-11.</p></li></ol></div>

<p>In the dynamic field of women's health, physiotherapy stands as a beacon of holistic care, transcending the traditional confines of physical treatment. This discipline, enriched by insights from 'Obstetrics by Ten Teachers', 'Gynaecology by Ten Teachers', and 'National Guidelines for Quality Obstetrics and Perinatal Care', offers a well-rounded approach to health, particularly for pregnant women and those with gestational diabetes. This article delves into the intricacies of diet and nutrition, exercise, yoga, ergonomics, healthy habits, and personal hygiene, highlighting their collective impact on women's health.</p><h3>Diet and Nutrition : The Foundation of Women's Health</h3><p>Proper nutrition is a cornerstone of health, especially during the crucial phases of pregnancy and lactation. Women's bodies require a symphony of nutrients to support their own health and that of their developing babies. Key nutrients include calcium, crucial for bone health and a vital component in preventing osteoporosis; iron, essential for combating anemia, especially significant during menstruation and pregnancy; folate, a B-vitamin critical for preventing birth defects and aiding in fetal brain development; and vitamin D, vital for overall health and immune function.</p><p>A balanced diet, rich in fruits, vegetables, lean proteins, whole grains, and healthy fats, supports not just physical health, but also mental well-being. For those with specific conditions like gestational diabetes, diet plays a therapeutic role. A low-glycemic diet rich in fiber, lean protein, and healthy fats helps regulate blood sugar levels, ensuring both maternal and fetal health.</p><h3>Exercise and Yoga: Enhancing Physical and Mental Well-being</h3><p>Physical activity is a pillar of health, offering benefits that extend beyond weight management. Cardiovascular exercises, such as walking, swimming, or cycling, improve heart health and enhance circulatory efficiency. Strength training, often overlooked, is crucial for maintaining muscle mass and bone density, particularly important in preventing osteoporosis. Yoga, with its emphasis on flexibility, balance, and mental focus, offers a unique set of benefits. During pregnancy, yoga can alleviate common discomforts like back pain, enhance circulation, and prepare the body for childbirth through focused breathing and relaxation techniques. Moreover, the mental benefits of yoga, including stress reduction and mindfulness, contribute significantly to overall well-being.</p><h3>Ergonomic and Hygiene Practices for Optimal Health:</h3><p>Ergonomics, particularly in the context of women's health, involves designing work and home environments that support physical well-being. Proper ergonomic practices reduce the risk of musculoskeletal disorders, a common ailment among women due to their diverse roles and responsibilities. During pregnancy, ergonomic adaptations are essential to accommodate the changing body and prevent strain and injury.</p><p>In addition to ergonomics, personal hygiene plays a crucial role in women's health. Regular bathing, proper genital care, and appropriate menstrual hygiene practices are essential for preventing infections and maintaining overall well-being. This is particularly important during menstruation and pregnancy, when hormonal changes can affect the body's susceptibility to infections.</p><h3>Healthy Habits for a Balanced Life:</h3><p>Healthy habits form the bedrock of a balanced lifestyle. Quality sleep is essential for physical repair and mental clarity. Relaxation techniques and effective stress management are as important as physical health practices. Mental well-being, fostered through mindfulness and meditation, has a profound impact on overall health.</p><p>Hydration is another key aspect of healthy living. Drinking adequate water daily is crucial for bodily functions and can prevent common issues like urinary tract infections, which are more prevalent in women. Avoiding harmful habits such as smoking and excessive alcohol consumption is vital for long-term health and well-being.</p><p>In conclusion, the integration of physiotherapy with diet, exercise, ergonomics, healthy habits, and personal hygiene offers a comprehensive framework for enhancing women's health. This is especially important during transformative phases such as pregnancy and postpartum. The application of evidence-based practices, informed by authoritative sources, enables physiotherapists to make significant contributions to women's health, guiding them toward healthier, more balanced lives.</p><p>By understanding and addressing the unique needs of women at different life stages, physiotherapy can play a pivotal role in not just treating but also preventing a range of health issues. This proactive, holistic approach is the key to empowering women to take charge of their health and well-being.</p>

Volume - 1, Issue - 2

<h4>Background:</h4><hr class='mt-0' /><p>The term paralympic was considered as a pun combining paraplegic and olympic. Although it&#39;s origin is unclear, the term “Paralympic” is used to describe the Stoke Mandeville Games. The paralympic sport has grown and developed for the following three main reason</p><div><ul><li><p>Sports are an effective means of augmenting rehabilitation outcomes for people with disabilities.</p></li><li><p>People with disabilities have a right to participate in sports and should have the same opportunities as others.</p></li><li><p>Paralympic sport is ELITE, EXCITING AND INSPIRING.</p></li></ul></div><h4 class='mt-4'>History:</h4><hr class='mt-0' /><div class='history'><ul><li><p>1948 - First Stoke Mandeville Games</p></li><li><p>1949 - Second Stoke Mandeville Games</p></li><li><p>1956 - Third Stoke Mandeville Games</p></li><li><p>1957- The term “Paralympic” is to describe Stoke Mandeville Games</p></li><li><p>1960 - First Paralympic Games held in Rome</p></li><li><p>1964 - Second Paralympic Games held in Tokyo</p></li><li><p>1968 - Third Paralympic Games held in Israel</p></li><li><p>1972 - Fourth Paralympic Games held in Germany</p></li><li><p>1976 - Fifth Paralympic Games held in Canada</p></li><li><p>1980 - Sixth Paralympic Games held in Netherlands</p></li><li><p>1984 - Seventh Paralympic Games held in New York</p></li><li><p>1988 - Eighth Paralympic Games held in Seoul Korea</p></li><li><p>1992 - Ninth Paralympic Games held in Spain</p></li><li><p>1994 - Tenth Paralympic Games held in Norway</p></li><li><p>1996 - Eleventh Paralympic Games held in Atlanta</p></li><li><p>1998 – Twelfth Paralympic Games held in Japan</p></li><li><p>2000 - Thirteenth Paralympic Games held in Australia</p></li><li><p>2002- Fourteenth Paralympic Games held in Australia</p></li><li><p>2004 - Fifteenth Paralympic Games held in Greece</p></li><li><p>2006 - Sixteenth Paralympic Games held in Italy</p></li><li><p>2008 - Seventeenth Paralympic Games held in China</p></li><li><p>2010 - Eighteenth Paralympic Games held in Canada</p></li><li><p>2012 - Nineteenth Paralympic Games held in UK</p></li><li><p>2014 - Twentieth Paralympic Games held in Russia</p></li><li><p>2016 - Twenty first Paralympic Games held in Brazil</p></li><li><p>2018 - Twenty second Paralympic Games held in Russia</p></li><li><p>2020 - Twenty third Paralympic Games held in Korea</p></li><li><p>2022 - Twenty fourth Paralympic Games held in Japan</p></li><li><p>2024 - Twenty fifth paralympic Games are going to be held in France</p></li></ol></div><h4 class='mt-4'>Advent of Paralympics:</h4><hr class='mt-0' /><div><ul><li><p>It is commonly accepted that the Paralympic movement began in England in 1940’s. However, the concept of providing sports opportunities specifically for people with disabilities was pioneered by Sir Ludwig Guttmann.</p></li><li><p>Sir Ludwig Guttmann - Founding Father of the Paralympic Games.</p></li><li><p>Sir Ludwig Guttmann (1899-1980) was born into a Jewish family in Germany. He qualified as a medical doctor in 1924(MD) and began his lifelong specialization neurology and neurosurgery.</p></li><li><p>At Stoke Mandeville, Guttmann began a number of highly innovative methods of rehabilitation forpeople with spinal cord injury (SCI).</p></li><li><p>Chief among these was the inclusion of sport as an integral part of physical rehabilitation, as aninitiative. It ultimately lead to the establishment of the paralympic games. Sport as Rehabilitation</p></li><li><p>A hallmark of rehabilitation at Stoke Mandeville was that, patients were always encouraged to extend themselves physically - whether sitting up in bed during early rehabilitation from the unit, patients were expected to have high levels of physical independence.</p></li><li><p>As attractive as this game was for the patient, the use of the stick at the same time as propelling the wheelchair made the game unacceptably dangerous, and it was soon replaced by a variety of other sports, including archery, netball, javelin throw and snooker.</p></li><li><p>Guttman promoted sports as the most natural form of remedial exercise, restoring physical fitness, strength, coordination, speed, endurance and overcoming fatigue.</p></li><li><p>Guttman believed that sport was a vital means of achieving what he regarded as the ultimate aims of rehabilitation to make the spinally injured person as independent as possible and to restore him to his rightful place in social life.</p></li></ul></div><h4 class='mt-4'>Logo:</h4><hr class='mt-0' /><p>Official logo for the IPC (International Paralympic Committee) adopted in 2003. It comprises three agitos symbolising <strong>'spirit in motion'</strong> and <strong>'mind and body spirit'</strong>.</p><h4 class='mt-4'>Paralympic categories:</h4><hr class='mt-0' /><p>The five areas of resolution are that all paralympic systems of classification must be:</p><div class='history'><ul><li><p>Be consistent with the International Classification of Functioning Disability and Health (ICF)</p></li><li><p>Based on scientific evidence</p></li><li><p>Define eligible types of impairments</p></li><li><p>Define minimum impairment criteria</p></li><li><p>Classify impairments according to the extent of activity limitation caused</p></li></ul></div><p>Defining eligible types of Impairments: To date only ten types of Impairment have been eligible for Paralympic sports.</p><div class='history'><ul><li><p>Visual impairment</p></li><li><p>Impaired strength</p></li><li><p>Impaired range of movement</p></li><li><p>Limb deficiency</p></li><li><p>Leg length discrepancy</p></li><li><p>Hypertonia</p></li><li><p>Ataxia</p></li><li><p>Athetosis</p></li><li><p>Short stature</p></li><li><p>Intellectual impairment</p></li></ul></div><p>The above mentioned ten impairment types are eligible for various Paralympic sports; In order to compete in Paralympic sports, a person must be affected by at least one of the impairments listed above.</p><h4 class='mt-4'>Disability:</h4><hr class='mt-0'/><p>Those who are confirmed to a wheelchair, deaf, blind or missing a limb, those who have only one of a paired set of organs or those with behavioural, emotions and psychological disorders that substantially limit a major life activity are said to be disabled persons.</p><h4 class='mt-4'>Types:</h4><hr class='mt-0' /><div class='history'><ul><li><p>Amputee</p></li><li><p>Cerebral palsy</p></li><li><p>Spinal cord injury</p></li><li><p>Spina bifida</p></li><li><p>Polio</p></li></ul></div><h4 class='mt-4'>Biomechanics:</h4><hr class='mt-0'/><div><ul><li><p>The study of biomechanics of wheelchair propulsion played an important role in designing the equipment and improved athletic performance impact on wheelchair racing, basketball, rugby and handcycling.</p></li><li><p>Risks of mechanical over use are higher, due to overuse injuries, mobility can decrease.Neverthless high level sports performance is possible with the subsequent increases in physical fitness, health and mobility.</p></li><li><p>A properly fitted manual wheelchair should offer freedom and efficiency during propulsion.</p></li><li><p>The wheelchair users have been encouraged to use a more forward long smooth strokes during the propulsive phase.</p></li><li><p>Higher stroke frequencies have been shown to correlate to median nerve injury and lead to increased heart rate and cardio respiratory stress.</p></li><li><p>A racing chair used in combination with correct propulsion biomechanics canresult in an extremely efficient means of movement above and beyond all other hand rim sport.</p></li><li><p>A racing chair’s primary steering is however is controlled by the upper body&#39;s interaction with the front wheel, where pressure can be applied to handle the bars, which turn the front wheel from left to right.</p></li><li><p>The racing stroke as a technique where the extensive shoulder extension and abduction during the backswing lead to increased hand speed at the impact energy transfer phase.</p></li><li><p>There are a total of five phases</p><ol class='history'><li><p>Drive forward and downward</p></li><li><p>Push rim contact</p></li><li><p>Pushing through to the bottom of the push rims</p></li><li><p>Push off or fallow through</p></li><li><p>Elbow drive to the top</p></li></ol></li></ul></div><h4 class='mt-4'>In paraplegic:-</h4><hr class='mt-0' /><p>During the push phase:- triceps brachii, antero medial deltoid, pectoralis major are more active During the recovery phase:- subscapularis, supraspinatus, middle trapezius are more active In Quadriplegic:- Activation of pectoralis major seems to be more prolonged when compared to paraplegic</p><h4 class='mt-4'>Role of Physiotherapist in Paralympics:</h4><hr class='mt-0' /><p>It is interesting to find out how the physiotherapist involved in the Paralympics. The Olympic ambition will lead to an increase in the number of active sports participants, which will have both positive and negative consequences in the sense of more sports injuries, increase in costs as a result of sports injuries. This is where the role of the physiotherapist comes into play, which will become increasingly prominent in guiding sports participants.</p><h4 class='mt-4'>Muscles to be strengthened:-</h4><hr class='mt-0' /><div class='history'><ol><li><p>Shoulder elevators, depressors, flexors, adductors</p></li><li><p>Scapula elevators</p></li><li><p>Elbow flexors, extensors and Forearm supinators, pronators</p></li><li><p>Trunk mobilization</p></li><li><p>Pelvic rotators and elevators</p></li><li><p>Hip extensors, flexors and adductors</p></li><li><p>Knee flexors and extensors</p></li></ol><h4 class='mt-4'>Strength training benefits:</h4><hr class='mt-0' /><ul><li><p>Increase bone mineral density</p></li><li><p>Improve glucose metabolism</p></li><li><p>Avoid muscle loss</p></li><li><p>Reduce low back pain</p></li><li><p>Reduce resting blood pressure</p></li></ul> <h4 class='mt-4'>Trainings so vital:</h4><hr class='mt-0' /><ol><li><p>Range Of Movement (ROM) of all joints to prevent thrombosis, improve mobility and to gain strength</p></li><li><p>Mobility training for trunk, shoulder and pelvis</p></li><li><p>Resistive exercises practiced on the sound limb</p></li><li><p>Training for weight transfers, crutch walking, wheelchairs etc.</p></li><li><p>Chest exercises</p></li><li><p>Assessing the athlete’s ROM and strength</p></li><li><p>Training for single limb standing and balancing</p></li><li><p>Flexibility and strengthening programme</p></li></ol><p>Last but not least, lots of talking, boosting of the morale of the patient plenty of sympathy and psychological reassurance</p><h4 class='mt-4'>Physiotherapeutic modalities</h4><hr class='mt-0' /><ul><li><p>Ultrasound</p></li><li><p>TENS</p></li><li><p>Electric stimulation</p></li><li><p>LASER therapy</p></li><li><p>Soft tissue manipulation</p></li><li><p>Cryotherapy</p></li><li><p>Hot packs</p></li><li><p>Therapeutic exercises</p></li></ul></div><h4 class='mt-4'>Conclusion</h4><hr class='mt-0' /><p>Physical benefits:- General fitness, CVS conditioning, postural control, flexibility, muscle strength, balance</p><p>Psychological benefits:- Impaired motivation, self confidence, self esteem, competitive spirit Physical Medicine &amp; Rehabilitation (PM&amp;R) in Christian Medical College (CMC) Vellore, Tamil Nadu, India</p><p>The history of PM&amp;R in India is intertwined with the personal story of Dr.Mary Verghese. The tragedy of a road traffic accident that rendered her paraplegic inspired her to establish a department of PM&amp;R in Vellore and a Rehabilitation institute, the first of its kind in the country. The field of the physical medicine and rehabilitation which deals with the comprehensive care ,for persons with disability, to make them physically independent.</p><h4 class='mt-4'>Elite Paralympic Athlete’s:</h4><hr class='mt-0' /><p>Aiming at success from wheelchairs. Spinal cord injury might have changed their lives competitively, but for young men who were treated and rehabilitated at PM&amp;R, CMC Vellore, overcame the challenges to make a difference. Spinal cord injuries posed numerous challenges for patients as they would loose sensation in the legs and would not be able to move. The department introduced wheelchair sports into the rehabilitation programme not on a competitive basis, but to expose the patients to sports and make them fit.</p><p>Mr .Venkatachalam who underwent rehabilitation at PM&amp;R Vellore had won the athletic events of discuss throw, shotput race in the Paralympics 2015 .He was devastated following the SCI and did not know what he was getting to do for the rest of his life on a wheelchair. But being part of sports has energised him, made him fit and has won the recognition of being a Paralympic player.</p><h4 class='mt-4'>References:</h4><hr class='mt-0' /><div class='history'><ol><li><p>Introduction - vanlandewjick Hand Book of sports medicine The Paralympic Athelete</p></li><li><p>History of the Paralympic movement - Bailey,s (2007) Athelete first</p></li><li><p>Rehabilitation through the sport - Carvalhoj&amp;Forkas.A(2005)</p></li><li><p>Classification in Paralympics sports - Tweedy, SM &amp; Bourke.J(2009)</p></li><li><p>Biomechanics- Boninger,N.L,Koontz,et al (2005)</p></li><li><p>Aimimg at success from wheelchairs - article 140284123.ece(2016)</p></li><li><p>Pushrim of wheelchair - Boninger,et al(2005)</p></li><li><p>PM&amp;R- Dr.Mary verghese pioneer of Rehab Vellore (2017)</p></li><li><p>Role of Physiotherapist - Annual plan (2021)Disabled sports Netherlands</p></li><li><p>Role of physiotherapist in Paralympics - Foundation for history of physiotherapy foundation (2021)</p></li></ol></div>

<p>The presence of a physical therapist in the Neonatal Intensive Care Unit (NICU) has been found to be influential in reducing physical impairments and limitations in infants, as well as in educating the family on how to provide optimal care for their newborn. Two terms coined in the NICU that should be learned are ‘Early intervention’ & ‘Developmental supportive care’.</p><h4>EARLY INTERVENTION:</h4><hr class='mt-0'/><p>It is a prevention-focused program that aims to support the well- being of preterm infants and their families. It involves identifying and providing early support to children who are at risk of poor outcomes and can help prevent problems from occurring or address them before they worsen. Early intervention programs are often implemented soon after birth, when the infant's brain is still developing and interventions are most likely to have the greatest impact.</p><h4 class='mt-4'>DEVELOPMENTAL SUPPORTIVE CARE:</h4><hr class='mt-0'/><p>It is a practice model that aims to reduce stress and pain for babies, parents, and healthcare professionals in a neonatal unit. It also aims to provide babies with developmentally appropriate sensory experiences and maximize their neurological development. This approach can help reduce long-term cognitive and behaviouralproblems. <br/><br/>As a Physiotherapist in NICU, we can do....</p><p><strong>Nesting: </strong>In utero, the fetus is confined to an enclosed space with well-defined boundaries to support the development of physiological flexion. The boundaries allow a fetus to extend his arms and legs to meet resistance and subsequently recoil his extremities into a gently flexed position. This physiological flexion is necessary for the development of normal posture movement control. In the Nesting technique, the babies are protected inside a nest made out of rolls of cloth. It improves the comfort of neonates. The rolls can help them to feel boundaries and they can push up against the sides of the rolls comforting them (Fig-1). Nesting can be done while the infant is in the NICU and placed on a monitor that helps to ensure that the baby is physiologically stable. Because of the fragility of preterm infants, most NICUs have adopted a minimal handling and stimulation approach for very immature infants.</p><p><strong>Swaddling: </strong>Swaddling is the art of snugly wrapping a baby in a blanket for warmth and security. It can keep the baby from being disturbed by her startle reflex, and it can help her stay warm and toasty for the first few days of life until her internal thermostat kicks in. It may even help to calm the baby.</p><p><strong>Positioning: </strong>Preterm infants characteristically demonstrate low postural tone, with the amount of hypotonia varying with gestational age. Developmentally supportive positioning for infants in NICU may help to reinforce normal skeletal alignment and provide opportunities for normal movement patterns. In addition, positioning can provide skin care and support respiratory function. The combination of these three benefits can allow the infant to improve and longer sleep.</p><p>Research indicates that infants with long stays in NICU, who are not appropriately positioned, are at risk for positional plagiocephaly, and torticollis and may demonstrate a decrease in the quality and spontaneity of movement. The goal of neonatal positioning is to Optimize alignment toward a neutral neck-trunk position semiflexed, midline extremity posture, and neutral foot position. Hyperextension of the neck, Frequent head turning to the side, Lower extremity frogging, and use of Bigger diapers should be avoided.</p><div class='text-center mb-3 d-flex justify-content-center volOneIssueThreeImg'><img src='/assets/img/image-1(A).jpg' /><img src='/assets/img/image-1(B).jpg' /></div><p>Kangaroo Mother Care: It is a Special way of caring for preterm-low birth weight babies which is practiced in many cultures. It fosters their health and well-being by promoting physiologic stability, breastfeeding, infection prevention, and increased maternal confidence & bonding. Kangaroo care is also known as skin-to-skin contact and the baby is breastfed exclusively to the utmost extent. Direct contact is established by removing all the baby's clothes, except for their diaper, and lying them in a prone position on the mother's chest (the Baby’s abdomen should be at the level of the mother’s epigastria) (Fig-2). It has been found that kangaroo care can be neuroprotective as it supports brain plasticity. KMC can be started as soon as the baby is stable in the hospital and continued at home. Short KMC sessions can be initiated during recovery with ongoing medical treatment (IV fluids, oxygen therapy). During KMC, Mother’s breathing stimulates the baby’s breathing, thus reducing the occurrence of apnea. It also helps decrease maternal stress and depression.</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-2.png' /></div><p><strong>Therapeutic Massage:</strong> Infant massage (i.e. gentle and slow hand contact) is an early intervention approach to help with a newborn's tactile sense. There is some evidence to suggest that massage can help with growth and weight gain for low birth weight and premature babies, reduce the length of stay in the hospital, reduce neonatal stress, and promote sleep.</p><p>Massage therapy with moderate pressure may be useful. Research by Lu et al. has found that moderate- pressure massage therapy can cause greater daily weight gain in preterm infants than light- pressure massage therapy(Fig-3).</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-3.png' /></div><p><strong>Therapeutic Handling:</strong> The primary aims of handling include assisting the newborn to achieve maximal interaction with parents & caregivers, and facilitating postural & movement patterns appropriate to the infant’s adjusted gestational age. It includes care of a neonate around sleep/wake cycles time, no routine procedure, Providing 2-3 hrs of uninterrupted sleep, following “Minimal Handling” or “Quiet hour” Protocol, reducing noise, Reduce lights, and Clustering the caregiving procedure. Don’t disturb the baby all the time.</p><p><strong>Physical Activity:</strong> It has been proposed that a lack of physical stimulation might contribute to metabolic bone disease in preterm infants, leading to decreased bone mineralization and growth. Therefore, physical activity has been explored as an intervention to help promote bone mineralization and growth. Physical activity for neonates includes facilitating extension and flexion of the extremities, performing a range of motion exercises, and holding patients into flexion to help facilitate pushing against resistance. These exercises are usually completed for several minutes, several times a week for at least two weeks. Doğan et al. note that passive range of motion exercises may be beneficial for bone development, especially when applied to an infant's proximal joints.</p><p><strong>Multimodal stimulation:</strong> The use of tactile, vestibular, proprioceptive, visual & auditory stimuli to facilitate infant development has been reported. For auditory stimuli, Soft & soothing music is used. For the tactile stimulus Gentle touch, massage & swaddling, For Visual stimulus pictures/human faces, and bright toys are used. For the Vestibular stimulus gentle rocking movements, and swinging are beneficial.</p><p><strong>Non-Nutritive Sucking:</strong> High-priority functional activities in the NICU are sucking and swallowing. These actions should be supported by the physiotherapist and other caregivers. Non-nutritive sucking provides tactile stimulation to the intraoral structures and facial muscles through a pacifier or a glove-wearing finger (Fig-4). Research shows that non-nutritive sucking can help reduce the length of hospital stay and improve feeding behaviours. It can be done using pacifiers.</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-4.jpg' /></div><p><strong>Family Education:</strong> Family education is a substantial component of interventional care in the NICU. Understanding how to care for the preterm infant is important for posture and movement development, parent-infant attachment, and maintaining the baby's physiological stability. Coaching the family on how to best support the baby's motor development should include topics such as feeding, dressing, sleep positioning, playing and communicating, therapeutic holding, and carrying the newborn after discharge.</p><h4 class='mt-4'>OUR LIFE IN NICU: STORY OF A NICU GRADUATE</h4><hr class='mt-0' /><p>Hello, I am a ‘NICU graduate child’ means after birth I lived in the NICU for some days. My mother said that I was born 8 weeks earlier than the expected date of delivery, so everyone used to call me ‘preemie’. In NICU I made many friends. I heard that some of my friends were like me born premature and others had weak lungs (Respiratory distress syndrome), heart infections (Necrotizing endocarditis), brain tissue infections (Meningitis/Encephalitis), bleeding in the brain (Intraventricular hemorrhage), etc. But all were very strong fighters just like me. The room of the NICU was so strenuous and loaded heavily with noxious stimuli that we couldn’t handle it. The loud noise of machines, the flashing lights, frequent running of doctors and nurses used to frighten me. I was put on oxygen therapy by ‘O2 hood’, and the Nasogastric tube was inserted inside my nose for feeding, and for regulation of my body temperature I used to sleep under a Radiant heat warmer. Besides all these displeasures, I was under constant observation and great care by my neonatologist, physiotherapist, nursing staff, and many more people who always work with enthusiasm. For my weaker lungs, Dr. Neonatologist gave me SURFACTANT THERAPY that made my lungs stronger and helped me breathe efficiently. My Physiotherapist used to SWADDLE me to calm me down and help me regulate my body, giving me different POSITIONINGand NESTING, she used to do MASSAGE THERAPY to strengthen my muscles and CHEST PHYSIOTHERAPY to clear secretions from my lungs. She also taught me NON-NUTRITIVE SUCKING so that later on I can do breastfeeding nicely. My therapist also taught my mother to give KANGAROO MOTHER CARE (skin-to-skin contact) which had increased ‘Mother- Infant bonding’ between us. Gradually I started improving and gaining weight so they sent me home with my family!!</p><p>After living so long in my mother’s womb which is the calmest and safest place, suddenly coming to NICU was quite scary for me so used to cry, cry, and cry....But after realizing that how much care and help they are giving me I wanted to THANK them but I have no words to describe so again I started crying, crying, and crying......!!!</p>

<p>Impact of Physiotherapy in Head and Neck Cancer Head and neck cancer is broadly recognized as the seventh most frequently occurring type of cancer and consists of a various array of tumors affecting the upper aerodigestive tract. Despite the presence of various histologies, squamous cell carcinoma remains the most prevalent. Predominant risk factors include tobacco use, alcohol abuse, and oncogenic viruses, including human papillomavirus and Epstein-Barr virus. Head and neck cancer, comprising a range of malignancies affecting the oral cavity, pharynx, larynx, and surrounding structures, presents complex challenges in both treatment and rehabilitation.[1]</p><p>Physiotherapy plays a crucial role in the management of Oral, Head, and Neck cancer especially during and after Treatment. Here’s how physiotherapy can help [2]</p><div><ol><li><p>Restoration of Function and Mobility: Physiotherapy assists in restoring function and mobility to areas affected by surgery, radiation therapy, or chemotherapy. Therapists develop personalized exercise programs to improve strength, flexibility, and range of motion in the jaw, head, and neck.</p></li><li><p>Swallowing and Speech Therapy: Speech-language pathologists, often working closely with physiotherapists, help patients regain the ability to swallow and speak properly after treatment. This may involve exercises to strengthen swallowing muscles and techniques to improve speech clarity.</p></li><li><p>Pain Management: Physiotherapists use various techniques such as manual therapy, therapeutic exercises, and modalities like heat and cold therapy to manage pain and discomfort associated with cancer treatment.</p></li><li><p>Education and Support: Physiotherapists educate patients about self-care techniques, posture correction, and energy conservation strategies to optimize recovery and enhance the quality of life during and after cancer treatment. Overall, physiotherapy plays a vital role in addressing physical impairments, improving function, and promoting overall well-being in individuals undergoing treatment for oral, head, and neck cancer.</p></li></ol></div><p>TheraBite Jaw Motion Rehabilitation System: Enhancing Jaw Mobility in Head and Neck Cancer Rehabilitation TheraBite is a jaw motion rehabilitation system designed to improve jaw function, range of motion, and reduce trismus (limited mouth opening) often experienced by head and neck cancer patients. The device consists of a hand-held controller and custom-fit mouthpieces, allowing patients to perform exercises that gently stretch and mobilize the jaw muscles and temporomandibular joint (TMJ). Here's how TheraBite is typically utilized in the rehabilitation of head and neck cancer patients:</p><div><ol><li><p>Trismus Management: After surgical procedures or radiation therapy, patients may experience trismus due to scarring, fibrosis, or muscle stiffness. TheraBite helps gradually stretch the muscles and tissues, promoting increased mouth opening over time.</p></li><li><p>Improving Jaw Mobility: TheraBite exercises involve controlled, repetitive movements of the jaw, encouraging improved mobility and flexibility. Patients work with their physiotherapists or speech therapists to establish a customized exercise regimen based on their specific needs and limitations.</p></li><li><p>Pain Management: Jaw exercises with TheraBite can also help alleviate discomfort or pain associated with muscle tightness and restricted movement. The device allows patients to perform exercises at their own pace, adjusting the intensity as tolerated.</p></li><li><p>Functional Restoration: By promoting increased jaw mobility and mouth opening, TheraBite contributes to the restoration of essential functions such as chewing, swallowing, and speech. This is particularly beneficial for patients aiming to regain oral function and quality of life post-treatment.</p></li><li><p>Patient Education and Support: Physiotherapists play a crucial role in guiding patients in the safe and effective use of TheraBite, ensuring proper technique and monitoring progress. They also provide education on self-care strategies and offer support throughout the rehabilitation process.</p></li></ol></div><p>TheraBite is a valuable adjunctive tool in the comprehensive rehabilitation of head and neck cancer patients, facilitating improved jaw function, reduced trismus, and enhanced quality of life. Its integration into personalized treatment plans underscores the multidisciplinary approach required to address the diverse challenges faced by individuals undergoing treatment for head and neck cancer [3].</p><h4 class='mt-4'>References:</h4><hr class='mt-0' /><div class='history'><ol><li><p>Li T, Lu J, Yin Y, Qiu Q. Prognosis prediction and risk stratification in head and neck cancer. Frontiers in Oncology. 2022 Dec 30;12:1037001.</p></li><li><p>Pauli N, Andréll P, Johansson M, Fagerberg‐Mohlin B, Finizia C. Treating trismus: a prospective study on effect and compliance to jaw exercise therapy in head and neck cancer. Head & neck. 2015 Dec;37(12):1738-44.</p></li><li><p>Wu H, Zhou Z, Zhang C, Shen S, Liu J, Zhang C. The progress of post-treatment restricted mouth opening in oral and maxillofacial malignant tumor patients. Frontiers of Oral and Maxillofacial Medicine. 2021 Mar 30;3.</p></li></ol></div>

<p>The ability to engage with others is known as communication. In the realm of physiotherapy, through patient interaction, one can learn about the difficulties patients are having performing specific tasks. Also, a therapist is able to comprehend the psychological context of the patient and the extent of their disturbance. Additionally, the therapist can vocally encourage and build the patient's confidence. Effective communication is essential in physical therapy as it promotes trust, guarantees precise diagnosis, and streamlines treatment regimens.</p><p>Effective communication between the therapist and patients facilitates comprehension of exercises, methods, and goals of rehabilitation, hence improving patient compliance and results. Moreover, proficient communication fosters cooperation among medical experts, culminating in comprehensive patient care and enhanced general health.</p><p>Asking questions, confronting people, focussing, and verbally tracking are all forms of communication in physical therapy. Understanding when to employ each form is crucial for therapists. Therefore, it is not advisable to employ such a confrontation until a therapeutic relationship based on trust has been created.</p><p>Physiotherapists have to work with a specific patient for a minimum of six months and a maximum of one year. Thus, the therapist must use simple language that the patient can comprehend. Furthermore, the therapist will win over the trust of the patient—that is, the person with illnesses or injuries. They will bolster their confidence and inspire them. With the goal for the patient to make more of an effort and heal as quickly as feasible.</p><p>Core of the healthcare industry is communication. Establishing trust, verifying correct diagnosis, treatment plans, and patient compliance all depend on effective communication. Physiotherapists may establish a positive, upbeat environment that will inspire their patients by listening, empathizing, and giving thorough explanations. This will help them develop trust and rapport with their patients. Patients will feel more confident and motivated to achieve their goals as a result of this trust, which will also enable a more thorough grasp of their situation.</p><p>Physiotherapists can discover patients' problems by gathering important information by listening to patients describe their symptoms. With the assistance of a communication therapist, an accurate diagnosis and thorough assessment can be made. Nonverbal cues like body language can also be used in effective communication. Effective communication, education, and empowerment will enable patients to take an active role in their own rehabilitation by giving them the information and comprehension they need. Physiotherapists explain exercises using simple language, essential tools, and hands-on practice. This allows the patient to exercise correctly.</p><p>The therapist will encourage patients to promote exercises and lifestyle modifications by providing clear explanations, creating achievable goals, and providing support in order to ensure patient compliance through communication. Frequent communication also makes it possible to track development and make any required adjustments to treatment programs. The patient's psychosocial needs can be met by the therapist through interaction. A holistic approach is used by physiotherapists to address patients' physical, emotional, and social welfare as well as the psychosocial aspects of their experience, which include feelings like anxiety and fear.</p><p>By providing a secure environment for patients to communicate their worries and feelings, therapists help patients build confidence and trust. Furthermore, communication makes interdisciplinary collaboration easier, enabling therapists to work with other medical providers to meet patients' needs. To sum up, excellent communication is essential for physiotherapists to provide patients with quality therapy. The patient's life will eventually be improved by psychosocial education that promotes understanding, participation, and empowerment from the initial assessment through treatment planning.</p><p>Physiotherapists that possess great communication skills can form strong bonds with their patients, fostering physical rehabilitation and recovery to expedite the healing process.</p>

<h4>ABSTRACT:</h4><hr class='mt-0' /><p><strong>TITLE: </strong>“To find out effect of goldfish exercise in tobacco chewing person for temporomandibular joint dysfunction: an interventional study”</p><p><strong>OBJECTIVE: </strong>To find out the effect of goldfish exercise on pain in tobacco chewers. To find out the effect of goldfish exercise to increase ROM in tobacco chewers. To find out the effect of goldfish exercise on mouth opening in tobacco chewers.</p><p><strong>MATERIAL AND METHODOLOGY: </strong>Total 60 participant were selected after screening with inclusion and exclusion criteria. To collect data, the researchers used a standardized, temporomandibular joint disability index, VAS and mouth opening measurement. The questionnaire was distributed among the tobacco chewers, and they were asked to fill it out honestly and without any external influence. Once the data was collected, it was analysed using statistical methods to determine find out effect of goldfish exercise in tobacco chewing person for the temporomandibular joint dysfunction. The findings of the study were provided important insights of the effect of goldfish exercise in tobacco chewing person for temporomandibular joint dysfunction.</p><p><strong>RESULTS: </strong>Data were analyzing SPSS version 25.0. result of study showed that significant improvement shows is group A. pre &post significant difference (<0.05) P value between group A and B. Conclusion: After analyzing the data which were collected from in and around Amreli. It was found that maximum number of tobacco chewing person suffering from TMD dysfunction, VAS, MOUTH OPENING. This study shown that in, the group-A given the goldfish exercise technique was better and effective then group-B(control group).</p><p><strong>KEY WORDS: </strong>Goldfish exercise, Mouth opening, pain, Temporomandibular dysfunction, tobacco chewer</p><h4 class='mt-4'>INTRODUCTION:</h4><hr class='mt-0' /><p>The temporomandibular joint (TMJ) are located just anterior to the external auditory meatus. The TMJ is a synovial, condylar, modified ovoid, and hinge type joint with fibrocartilaginous surfaces rather than hyaline cartilage and an articular disc. Gliding, translation, or sliding movements occurs in the upper cavity of the temporomandibular joint, whereas rotation or hinge movement occurs in the lower cavity. The capsule of the temporomandibular joint is thin and loose. In the resting position, the is slightly open, lips are together, and the teeth are not in contact but slightly apart. In the closed packed position, the teeth are tightly clenched, and the head of the condyles are in the posterior aspect of the joint. Centric occlusion is the relation of the jaw and teeth when there is maximum contact of the teeth, and it is the position assumed by the jaw in the swallowing. The position in which the teeth are fully integrated is called the median occlusal position. The temporomandibular joints are two of the most frequently used joints in the body, but probably receive the least attention. It has been shown that temporomandibular disorders affect 10% to 15% of adults. Without these joints, one would be severely hindered when talking, eating, yawning, kissing, or sucking. Temporomandibular disorders consist of several complex of multifactorial ailments involving many interrelating factors, including psychosocial issues. Oral lesions (herpes zoster, herpes simplex, oral ulcer), muscle overuse (clenching, bruxism), trauma, systemic lupus erythematosus, rheumatoid arthritis, headaches, and cancer pain can mimic temporomandibular joint disorders. Three cardinal features of temporomandibular joint disorders are orofacial pain, restricted jaw motion, and joint noise.(1)</p><p>The diagnosis of the temporomandibular joint dysfunction will be interpreted by the noise is assessed by the sound heard in stethoscope. A grafting sound indicates perforation of disk or arthritic changes. Limited opening suddenly resolved after click indicates disk displacement with reduction. Reducted ROM without clicking may be suggestive of disk displacement without reduction. The signs and symptoms of TMD disorders are pain and tenderness around jaw, Pain in one or both of the TMJs, pain in and around ear, difficulty in chewing or pain while chewing, locking of joint. Making it difficult to open or close the mouth, headache, neck pain, mental depression. The areas where pain of TMJ can radiate are temporalis, masseter, trapezius, sternoclenomastoid. (2) Goldfish Exercise was developed by Japanese Health Care Practitioner-SEIGO NISHI.</p><p>This exercise was an outcome of inspiration on the concept of elegant swimming motion of the Goldfish. When this concept was put into practice, the Japanese realized its benefits at many levels. This newly found way of exercising became known in Japan as “KINGYO UNDO” or “GOLDFISH EXERCISE”. The pain assessment in systematically is essential for correct diagnosis. This pain is a subjective part for both patient and health care professionals. So, require a valid and reliable tool for measurement of pain. VAS is widely used as a measure of pain intensity in globally. It has been shown that VAS is valid, reliable and interval scale. VAS has high test-retest reliability and repeatability. VAS is used in epidemiological and clinical research to measure the intensity or frequency of a variety of clinical symptoms. In randomized controlled trials, clinical trials VAS is frequently used to determine the effectiveness of treatment as an outcome measure.</p><p>Recently, there are different type of scale are used for assessing pain but without any valid (accurate) and reliable (reproducible) instruments it is very difficult to find real effect of treatment. The intensity of pain is a quantitative estimation and the most commonly used pain scales are the Visual Analogue Scale (VAS), the Numerical Rating Scale (NRS) the Verbal Rating Scale (VRS). (3) The mouth opening is an important indication of the functionality of the temporomandibular joint. A limitation in the degree of opening can be symptom of TMJ dysfunction. It is usually defined as the distance between the incisor crests when the mouth is open maximum, or as the interincisal distance plus the overbite. The mouth opening is usually measured simply by asking the patient to their mouth open as wide as possible and measuring the distance between the edges of the frontal incisors with a ruler or calliper, and in some cases, the overlapping of the incisors is added.</p><p>All these methods have in common that the measurements is usually taken manually and are dependent on the experience of the professional taking them.(4) Temporomandibular joint disability index assesses pain and routine functional skills requiring oral functions. It has 10 sections of pain and disability during various activity. The patient was asked to circle the number which describes his problem best. Total scores out of 40 was calculated and converted into percentage. (5)</p><h4 class='mt-4'>Methodology:</h4><hr class='mt-0' /><p>The samples were be selected from the population on the of inclusion and exclusion criteria. Prior to the study, all patients were explained about the procedure, written informed consent was taken. Pre-participation evaluation form consisted of the demographic data of the patient that includes age, chief complain, history, previous surgery, pain assessment, range of motion. 60 patients having TMJ dysfunction was randomly taken from the in and around Amreli. They were randomly divides into two groups and they not know about group allocation. Group1: received goldfish exercise. Group2: control group. For 2 weeks duration, 5 times/week & No. of patients in each group = 30. The patients were requested to continue normal activities and avoid other forms of treatment for 2 weeks apart from routine physician treatment. Visual Analogue Scale (VAS), Mouth Opening (MO) and Temporomandibular Joint (TMJ) Disability Index were taken Pre and Post treatment.</p><div class='text-center mb-3 volOneIssueThreeImg'><img src='/assets/img/image-5.png' /></div><h4 class='mt-4'>Result:</h4><hr class='mt-0' /><p>Data were analysing SPSS version 25.0. with using pair and unpaired t test. result of study showed that significant improvement <0.05 P value shows is group A. pre &post significant difference (<0.05) P value between group A and B.</p><div><table class='table table-responsive table-hover'><caption>Table 1: - Describes the improvement in the TMD dys0function in the group A</caption><thead><tr><th></th><th colspan='2'>Mean ± SD</th><th></th><th></th><th></th></tr></thead><tbody><tr><td></td><td>Pre</td><td>Post</td><td>T</td><td>P</td><td>Result</td></tr><tr><td>TMD</td><td>11.6±6.7</td><td>4.6±3.2</td><td>9.17</td><td>0.00</td><td>Significant</td></tr><tr><td>VAS</td><td>6.5±0.9</td><td>4.61±1.1</td><td>9.06</td><td>0.00</td><td>Significant</td></tr><tr><td>MOUTH OPENING</td><td>2.25±0.5</td><td>3.3±0.5</td><td>-7.79</td><td>0.00</td><td>Significant</td></tr></tbody></table> <table class='mt-4 table table-responsive table-hover'><caption>Table 2:- Describes the improvement in the TMD dysfunction in the group B</caption><thead><tr><th></th><th colspan='2'>Mean ± SD</th><th></th><th></th><th></th></tr></thead><tbody><tr><td></td><td>Pre</td><td>Post</td><td>T</td><td>P</td><td>Result</td></tr><tr><td>TMD</td><td>11.1±6.15</td><td>10.9±5.9</td><td>1.98</td><td>0.06</td><td>Not-Significant</td></tr><tr><td>VAS</td><td>6.12±1.1</td><td>6.2±1.01</td><td>-4.38</td><td>0.05</td><td>Not-Significant</td></tr><tr><td>MOUTH OPENING</td><td>3.05±0.4</td><td>2.9±0.4</td><td>2.63</td><td>0.13</td><td>Not-Significant</td></tr></tbody></table></div><div class='text-center mb-3'><img src='/assets/img/image-6.png' /></div><h4 class='mt-4'>Discussion:</h4><hr src='mt-0' /><p>The aim of the study to find out the effect of goldfish exercise in tobacco chewing person for temporomandibular joint dysfunction. The study utilized a interventional design, and data were collected in and around Amreli. the study included 60 tobacco chewing person. And divided into two groups. Group A recived goldfish exercise and group B was control group. The result of the study revealed significant differences exists between two groups they received the goldfish exercise and control group. Hence, the alternate hypothesis stating that there is significant differences between goldfish exercise and control group on tobacco chewing person can be accepted and the null hypothesis can be rejected. Subjects who recived goldfish exercise showed improvement with the outcome measure. Subjects who are in control group didn’t showed improvement with the outcome measure. But on comparing both the group. Group A seems more effective. The outcome measure will be used are used are VAS scale, TMJ disability index and increase in mouth opening. While the control group showed no statistical reduction on pain, TMJ disability index, mouth opening measurement. Goldfish exercise works on the principle of pulsatile motion of goldfish in water & thereby imitating the same motion for health benefits. It can be thought of stretching the fibrous bands, reducing TMJ stiffness & resulting in improvement in mouth opening. It would be beneficial to use this technique on daily basis and as far there are no contraindications of this exercise because it`s done with in pain limits& further progression depends on the mouth opening of the patient. Goldfish exercise can be given to the patients having jaw problems and even taught for home exercise program. However, there was a significant result was noticed in the Group A i.e. goldfish exercise, when t-test is performed to find out the effect.</p><h4 class='mt-4'>Conclusion:</h4><hr class='mt-0' /><p>After collecting and analyzing the data which collected from in and around Amreli. It was found that maximum number of tobacco chewing person suffering from temporomandibular joint dysfunction. This study shown that in, the group A given the goldfish exercise technique was better and effective in temporomandibular joint dysfunction then group B (control group)</p><h4 class='mt-4'>References:</h4><hr class='mt-0' /><div class='history'><ol><li><p>DAVID J. MAGEE, ROBERT C.MANSKE. orthopaedic physical assessment seventh edition page no :(243)</p></li><li><p>MEGHA S.SHETH, PRIYA SING RANGEY. Physiotherapy in orthopedic and rheumatologic conditions page no:(446-447)</p></li><li><p>Setoo jain, yagna umesh Shukla: EFFECT OF GOLDFISH EXERCISE ON PAIN,MOUTH OPENING,AND TEMPOROMANDIBULAR JOINT DISABILITY IN ORAL SUBMUCOUS FIBROSIS -A RANDOMIZED CONTROL TRIAL. January 2017</p></li><li><p>Franco Marinelli, maria florenica lezcano, Josefa Alarcon: A NOVEL TECHNIQUE TO ACCURATELY MEASURE MOUTH OPENING USING 3D ELECTROMAGNETIC ARTICULOGRAPHY. October 2022.</p></li><li><p>Azizfatema munawer khan, megha s. sheth, romsa r. purohit: Effect of areca nut chewing and maximal mouth opening in schoolgoing children in Ahmedabad. December 2016</p></li><li><p>Toby n. Weingarten,barton c. Iverson, Kevin I. Reid “Impact of tobacco use on the symptoms of painful temporomandibular joint disorder” at 2019.</p></li><li><p>Mst. Rabea Begum1 *, Mohammad Anwar Hossain “VALIDITY AND RELIABILITY OF VISUAL ANALOGUE SCALE (VAS) FOR PAIN MEASUREMENT” at 2019.</p></li></ol></div>

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