Rajiv Gandhi University of Health Sciences, Karnataka,
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
| | |NABARUN SAHA |
|1 |Name of the Candidate |NARENDRA NIBASH, CHIRUKANDI, N.H. BYPASS, SILCHAR, CACHAR, ASSAM PIN - 788003 |
| |& Address | |
| | |KRUPANIDHI COLLEGE OF PHYSIOTHERAPY, BANGALORE. |
|2 |Name of the Institution | |
| | | |
|3 |Course of study and subject |MASTERS IN PHYSIOTHERAPY |
| | |(NEUROLOGICAL AND PSYCHOSOMATIC DISORDERS) |
| | | |
|4 |Date of admission to course | |
| | |
| |TITLE OF THE TOPIC: |
|5 | |
| |“Effect of Respiratory Muscle exercise to improve walking capacity on stroke subjects” |
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| | |
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|6 |Brief resume of the intended work: |
| | |
| |6.1 Introduction: |
| | |
| |WHO defined stroke as ‘rapidly developed clinical sign of focal disturbance of cerebral function, lasting more than 24 hrs or leading to |
| |death, with no apparent cause other than vascular origin. The 24 hours threshold in the definition excludes Transient Ischemic Attacks (TIA).1|
| | |
| | |
| |Stroke is caused either by ischaemia or haemorrhage and non-progressive in nature. There are several risk factors associated with stroke and |
| |can occur at any age more commonly in the elders. The interruption of blood flow to the brain to the brain leaves the patient with a focal |
| |loss of function of varying severity. The neurological deficit ranges from a temporary loss of function followed by complete recovery, to |
| |permanent life-altering impairment and disability, to death. The severity signs and symptoms are worse initially and declines with time and |
| |treatment intervention. |
| | |
| |Therapeutic mobility and exercise training after stroke presents many challenges due to an asymmetrical gait pattern, decreased walking speed,|
| |and increased energy expenditure during activity. 2 |
| | |
| |There is a need to improve cardiorespiratory fitness so that individuals participating in stroke rehabilitation can tolerate functional |
| |mobility training and activities. 3 |
| | |
| |Although not all patients after stroke have overt pulmonary disease4, respiration may be compromised as a direct result of the stroke itself |
| |(particularly brain stem stroke), associated complications (e.g., weakness of respiratory muscles, impaired breathing mechanics), |
| |comorbidities (e.g., chronic obstructive pulmonary disease, cardiovascular dysfunction), or lifestyle factors (e.g., physical inactivity high |
| |incidence of smoking). The excessive fatigue experienced by some people after stroke may be partly due to respiratory insufficiency. 5 |
| | |
| |Need for the study: |
| | |
| |Respiratory exercises when included in rehabilitation program in stroke patient may help in improving functional outcome and activities of |
| |daily living. Since there is limited study on outcome measure like walking capacity of the stroke patient in relation to respiratory exercises|
| |I intend to do the study on effect in respiratory exercise to improving walking capacity in stroke survivors. |
| | |
| |Objectives of the study: |
| | |
| |To find out the improvement in walking capacity in stroke patient with respiratory muscle training. |
| | |
| |Hypothesis |
| | |
| |Null Hypothesis: |
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| |There is no significant difference exists between Group I (experimental group) receiving both respiratory exercise and conventional exercise |
| |and Group II (control group) receiving only conventional exercise on walking capacity. |
| | |
| | |
| | Alternate Hypothesis: |
| | |
| |There is significant difference exists between Group I (experimental group) receiving both respiratory exercise and conventional and group II |
| |(control group) getting only conventional exercise on walking capacity. |
| | |
| |Review of Literature: |
| | |
| |Richard Zorowitz, et.al. (2004)6 stated that as stroke mortality has declined in the last few decades, the number of stroke survivors with |
| |impairments and disabilities has increased. There are 300,000 to 400,000 stroke survivors annually. 78% to 85% of stroke patients regain |
| |ability to walk (with or without assistive device). 48% to 58% regain independence with their self-care skills. 10% to 29% are admitted to |
| |nursing homes. |
| |Sandra Billinger (2010)7 stated that most individuals after stroke are deconditioned and have low levels of cardiorespiratory fitness. The |
| |goal should be to obtain the optimal cardiorespiratory fitness for people post-stroke that will also lead to important functional activity |
| |gains during rehabilitation. Cardiorespiratory fitness varies according to age, gender, physical activity levels, body composition, and the |
| |absence or presence of chronic disease or disability. In the poststroke population, the literature suggests that CR fitness is reduced by as |
| |much as 50% when compared to age-matched sedentary counterparts. The extent of deterioration is associated with several clinically relevant |
| |biological correlates which were the focus of this review. |
| |Sutbeyaz ST et.al.(2010)8 in a randomized control trial found that there is a significant short-term effects of the respiratory muscle |
| |training programme on respiratory muscle function, exercise capacity and quality of life were recorded in this study. |
| |Ada Tang (2006)9 in his study suggest that although the 6MWT may challenge the cardiorespiratory system in sub acute stroke survivors, it is |
| |representative of the ability for functional ambulation and is not an adequate measure of aerobic fitness alone. The findings demonstrate |
| |positive correlations between gait speeds obtained from various measures of walking function and, more importantly, highlight differences |
| |between them. |
| |Regine Bastin (1997)10 advocated that Incentive Spirometer can be used as a simple mean to follow lung function, especially Vital Capacity and|
| |Inspiratory Respiratory Volume, at the bedside in the postoperative period in patients breathing spontaneously. Incentive Spirometer is |
| |noninvasive and can be performed repeatedly at the bedside in the intensive care setting. Incentive spirometry has been shown to be at least |
| |as efficient as other methods (intermittent positive pressure breathing, deep breathing exercises). 5-7 It is used extensively because it |
| |encourages deep breathing and needs minimal supervision. |
| |Assunta Pizzi (2007)11, in his observational study stated that, the Wisconsin Gait Scale is a useful tool to rate qualitative gait alterations|
| |of post-stroke hemiplegic subjects and to assess changes over time during rehabilitation training. It may be used when a targeted and |
| |standardized characterization of hemiplegic gait is needed for tailoring rehabilitation and monitoring results. |
|7 | |
| |MATERIALS AND METHODS: |
| | |
| |7.1 Source of data: |
| | |
| |Population: Subjects with stroke in and around Bangalore who comes in inclusion criteria who comes for treatment. |
| |Sample Size: a total number of 30 subject of both gender |
| | |
| |Material |
| |Record or data collection sheet. |
| |Stop watch. |
| |Measuring tape. |
| |Incentive Spirometer |
| |Methods |
| | |
| |Sampling technique: |
| |Convenient sampling where 30 male and female subjects referred by physician after diagnosing stroke will be divided in to two groups of 15 |
| |each alternatively as per referral. |
| | |
| |Group I : (Experimental group) Will receive Respiratory exercise and conventional stroke rehabilitation programme. |
| | |
| |Group II : (Control group) Will receive conventional stroke rehabilitation programme. |
| | |
| |Methodology |
| |Study design : |
| |Experimental study |
| |Inclusion criteria |
| |Subjects who have had stroke at least 6 months ago. |
| |Are able to walk at least 10m independently. |
| |Modified Ashworth Scale score more than 1 in their ankle plantar flexors |
| | |
| |Exclusion criteria |
| |Unstable cardiopulmonary status |
| |Unstable or Uncontrolled hypertension |
| |COPD |
| |Painful Osteoarthritis of knee. |
| |Cognitive impairment. |
| |Hearing Impairment |
| | |
| |Procedure |
| |A total of 30 subjects will be selected based on the inclusion and the exclusion criteria. An informed consent would be obtained from them to |
| |participate in the study. Having included them in the study, these patients will be randomly assigned to experimental and control group with |
| |15 patients in each group. A brief orientation about the study and the interventional procedure would be given to both the groups. The control|
| |group will receive conventional physiotherapy treatment thrice a week for a period of six weeks, with a single treatment sitting lasting for |
| |60 minutes. |
| |The experimental group will receive the same treatment as that of the control group, but additionally, they will be given Respiratory |
| |exercise. This additional training will be given at the end of the conventional treatment. Hence the overall treatment time for the |
| |experimental group will last for 90 mins, which will increase the treatment duration by 30 minutes. |
| |The procedure of the conventional treatment is as follows: |
| |Inhibition of tone for spastic group of muscle |
| |Facilitation for improving muscle performance out of synergic pattern. |
| |Active assisted exercises for lower limb |
| |Selective stretching exercises for both upper and lower limb |
| |Weight bearing exercises for the lower limb |
| |Strengthening exercises for the lower limb |
| |Walking around the bed or treatment table |
| |Procedure for Breathing exercise: |
| |Diaphragmatic Breathing exercise |
| |Chest expansion exercises |
| |Incentive Spirometer |
| | |
| |Statistical analysis |
| |Parametric and non-parametric test will be used. |
| | |
| | |
| |7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe |
| |briefly. |
| | |
| |Yes, this study will be done on human’s and intervened with Physiotherapy protocol. |
| | |
| |7.4 Has ethical clearance been obtained from your institution in case of 7.3. |
| | |
| |Yes, the ethical clearance has been obtained from the institution. |
| | |
|8 |List of References: |
| | |
| |Srikanth V, Read SJ, Thrift AG et al. Poverty and stroke in India. A time to act. Stroke. 2007;38: 3063-3069. |
| |Macko RF, DeSouza CA, Tretter LD, et al. Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of |
| |hemiparetic gait in chronic stroke patients. A preliminary report. Stroke.1997;28:326-330. |
| |Billinger, Sandra., Cardiovascular Regulation after Stroke: Evidence of Impairment, Trainability, and Implications for Rehabilitation. Cardio |
| |Phy Th Journal 2010; 21-24. |
| |S. T. Sutbeyaz, F. Koseoglu, L. Inan, and O. Coskun, “Respiratory muscle training improves cardiopulmonary function and exercise tolerance in |
| |subjects with subacute stroke: a randomized controlled trial,” Clin Rehab, 2010,24: 240–250. |
| |F. Vingerhoets and J. Bogousslavsky, “Respiratory dysfunction in stroke,” Clin Chest. Med., 1994; 15: 729–737. |
| |Richard Zorowitz, M.D., Edgardo Baerga, M.D., and Sara Cuccurullo, M.D. Stroke Rehabilitation , Physical Medicine and Rehabilitation Board |
| |Review. New York: Demos Medical Publishing; 2004. Available from |
| |Sandra Billinger, Cardiovascular Regulation after Stroke: Evidence of Impairment, Trainability, and Implications for Rehabilitation. |
| |Cardiopulm Phys Ther J. 2010; 21: 22–24 |
| | |
| |Sutbeyaz ST, Koseoglu F, Inan L, Coskun O., Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects |
| |with subacute stroke: a randomized controlled trial. Clin Rehabil. 2010;24:240-50. |
| |Ada Tang, Kathryn M Sibley, Mark T Bayley, William E McIlroy and Dina Brooks, Do functional walk tests reflect cardiorespiratory fitness in |
| |sub-acute stroke? J. of NeuroEngg and Rehab, 2006, 3:23. Available from |
| | |
| |Re´gine Bastin, Jean-Jacques Moraine, Gizella Bardocsky, Robert-Jean Kahn, and Christian Me´lot, Incentive Spirometry Performance A Reliable |
| |Indicator of Pulmonary Function in the Early Postoperative Period After Lobectomy? CHEST 1997; 111:559-63 |
| |Assunta Pizzi, Giovanna Carlucci, Catuscia Falsini, Francesco Lunghi, Sonia Verdesca and Antonello Grippo Gait in Hemiplegia: Evaluation of |
| |clinical features with the Wisconsin Gait Scale, J Rehabil Med. 2007;39:170-174. |
| |Marco Y.C.Pang, Janice J. Eng, and Andrew S.D., Relationship Between Ambulatory Capacity and Cardiorespiratory Fitness in Chronic Stroke |
| |Influence of Stroke-Specific Impairments CHEST 2005;127:495–501. |
| |Janice J. Eng, Kelly S. Chu, Andrew S. Dawson, C.Maria Kim and Katherine E. Hepburn Functional Walk Tests in Individuals With Stroke: Relation|
| |to Perceived Exertion and Myocardial Exertion, Stroke. 2002;33:756-761. |
| |Rodriquez AA, Black PO, Kile KA, Sherman J, Stellberg B, McCormick J, Roszkowski J, Swiggum E. Gait training efficacy using a home based |
| |practice model in chronic hemiplegia. Arch Phys Med Rehb 1996;77: 801-805. |
| |Rubertone JA, Balwin K, Bucknum J, Elias S, Mitchell D, Sukenick J. Reliability analysis of the Wisconsin Gait Scale for novice evaluators. |
| |The Annual Conference and Exposition of the American Physical Therapy Associatio; Indianapolis, Available from |
| |display/citfd322229 |
| |Wellmon R, Campbell SL, Rubertone JA, Ellison M, King R, Meduri C, et al. The interrater and intrarater reliability of the Wisconsin Gait |
| |Scale when administered by physical therapists to individuals post-stroke. Proceedings of the American Physical Therapy Association Combined |
| |Sections meetings. Tampa, Florida, 2003. |
| |Lewis C. On balance: Using the Wisconsin Gait Scale. Geriatric Function 2007; 18:8. Available from |
| | On-Balance-Using-the-Wisconsin-Gait-Scale.aspx |
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|9 |Signature of Candidate |(Nabarun Saha) |
| | | |
|10 |Remarks of the Guide | |
| | | |
| | | |
|11 |Name and Designation (in block letters) | |
| |11.1 Guide | |
| | | |
| |11.2 Signature | |
| | | |
| |11.3 Co-Guide ( if any ) | |
| | | |
| |11.4 Signature | |
| | |Mr. MASIH MUHAMMAD KHAN MPT |
| |11.5 Head of Department | |
| | |(MUSCULOSKELETAL DISORDERS AND SPORTS PHYSIOTHERAPY) |
| | | |
| |11.6 Signature | |
| | | |
|12 |12.1 Remarks of the Chairman & Principal | |
| | | |
| |12.2Signature : | |
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