Indonesian Journal of Physical Medicine and Rehabilitation

Ultrasonography is a Highly Valuable Technology in Clinical Practice

Rita Vivera Pane — Thu, 27 Jun 2024 00:00:00 +0700

Technological advancements have significantly impacted healthcare services, including the field of physical medicine and rehabilitation. One prominent emerging technology is ultrasound, which has
evolved beyond its traditional role as a diagnostic tool to facilitate therapeutic interventions, such as muscle training therapies and injections targeting neural or musculoskeletal structures. Exercise
therapies aimed at isolating specific muscle contractions are crucial, and ultrasound imaging aids in accurately targeting the desired muscles. For a medical rehabilitation specialist, proficiency in ultrasound usage is essential for daily practice.
Given its integral association with “physical” aspects, physical medicine and rehabilitation require an understanding of movements, such as concentric and eccentric actions involving the origins and insertions of muscles. Additionally, ultrasound provides detailed visualizations of muscle fascia in various conditions—whether normal or edematous—fibrotic changes in muscles due to prolonged immobility, atrophy in sarcopenia, and muscles that have been improperly utilized. It also offers
insight into spastic muscle fibers, entrapped nerves, edematous nerves, linear fractures, and other features not visible on X-Ray, due to its ability to capture dynamic images of the targeted structures. Managing spasticity through chemoneurolysis injections, such as botulinum toxin, phenol, alcohol, or interventions like cryotherapy or lidocaine nerve blocks, is greatly enhanced by advancements in ultrasound technology

Comparison of Lumbar Stabilization Exercise and Flexibility Exercise on Lumbal Flexibility in Chronic Mechanical Lower Back Pain (Study on Online Motorcycle Drivers)

Martin, Endang Ambarwati, Rahmi Isma AP — Thu, 27 Jun 2024 00:00:00 +0700

Background : Flexibility plays an important role in increasing a person's capacity to perform daily activities. Decreased lumbar spine flexibility is both a will cause and a consequence of low back pain. Lumbar stabilization exercise and flexibility exercise are options that can be given for chronic mechanical low back pain.

Objective: This study was knew the difference in the effect of lumbar stabilization exercise compared to flexibility exercise on lumbar flexibility in online motorcycle drivers with chronic mechanical low back pain.

Methods: 26 subjects who fullfill the inclusion and exclusion criteria were randomly divided into the lumbar stabilization exercise group (n=13) and the flexibility exercise group (n=13). Each group was exercised five times a week for six weeks at home. Measurement of lumbar flexibility was performed using the modified-modified schober test and sit and reach test at baseline before the intervention and 6 weeks after the intervention.

Results: Comparison of the delta value of the modified-modified schober test (p = 0.029) and the delta value of the sit and reach test (p = 0.025) between groups were showed significant differences in the lumbar stabilization exercise group compared to the flexibility exercise group.

Conclusion: Giving the intervention of lumbar stabilization exercise and flexibility exercise were increased lumbar flexibility. However, the lumbar stabilization exercise intervention was a better on increasing lumbar flexibility than flexibility exercise for online motorcycle drivers with chronic mechanical low back pain.

Effectiveness of Adding Lower Extremity Isotonic Exercise on Hamstring Flexibility of Hajj Pilgrims Who Receive Walking Aerobic Exercise

Hodijah, Rudy Handoyo, Robby Tjandra Kartadinata — Thu, 27 Jun 2024 00:00:00 +0700

ABSTRACT

Introduction: Hajj is a pilgrimage that is mostly carried out walking. One of the muscles that plays an important role in walking activities is hamstring muscle. The hamstring muscles often experience shortening (tightness), so exercises to increase the flexibility of the hamstring muscles are something that needs to be done. The goals of this study is to investigate the effect of adding lower extremity isotonic exercise on hamstring flexibility in hajj pilgrims who receive walking aerobic exercise.

Method: A randomized controlled trial was used for this research. A total of 36 individuals were divided into an 18-person treatment group and an 18-person control group. The groups received walking aerobic exercises five times a week and the treatment group were added lower extremity isotonic exercise twice a week. A sit-and-reach test was used to evaluate hamstring flexibility both before and after a six-week course of treatment.

Result: After six weeks, there was a significant increase in hamstring flexibility in both the treatment group (p=0.0000) and the control group (p=0.0001). The treatment group experienced a significantly better improvement in hamstring flexibility (5,39 ± 3,47) compared to the control group. (2,17 ± 1,79) (p=0,001).

Conclusion: Adding lower extremity isotonic exercise can significantly increase hamstring flexibility higher than aerobic walking exercise alone in hajj pilgrims.

Keyword: hajj pilgrims, hamstring flexibility, aerobic walking exercise, lower extremity isotonic exercise

Rehabilitation Treatment Of Tuberculosis Of The Knee Joint (Gonitis Tuberculosis) After Synovectomy Surgery: A Case Report

Heru Wahyudi, Mami Losa Rama Susilawati — Thu, 27 Jun 2024 11:47:13 +0700

Introduction: The incidence of extrapulmonary tuberculosis (EPT) cases is increasing globally. with bones and joints being the most common sites, accounting for over 10% of occurrences. Tuberculosis of the knee is rare case, presents challenges in prompt diagnosis, leading to severe progressive pain and functional impairment that significantly impacts the patient's quality of life.

Case Persentation: A 42-year-old male patient experienced chronic pain in the right knee joint, stiffness and limitations when moving the knee. Physical examination showed swelling, warmth and redness. The range of movement of the knee was limited. Histopathological examination showed that the patient was diagnosed with tuberculosis of the knee. Synovectomy was performed after a diagnosis of tuberculosis of the knee and followed by a 9-month anti-tuberculosis drugs regimen. Knee range of motion (ROM) exercise and diathermy therapy showed clinical improvement after prompt management since the initiation of progressive rehabilitation therapy.

Conclusion: Tuberculosis of the knee is a rare complication of tuberculosis which has the potential to cause functional impairment and affect the quality of life. Providing physiotherapy interventions in the form of exercises and diathermy therapy in post-synovectomy cases for one year resulted in significant functional progress.

Rehabilitation Management of a Child with Severe Pain after Bacterial Meningoencephalitis

Budiati Laksmitasari, Luh Karunia Wahyuni, Rizky Kusuma Wardhani, Binar Sasono — Thu, 27 Jun 2024 00:00:00 +0700

Introduction: Pain is a common finding in children with meningoencephalitis and can cause negative consequences. We reported a child with severe pain after Acinetobacter meningoencephalitis who underwent rehabilitation management in the outpatient setting.

Case description: A 1-year-4-month-old child was brought to the rehabilitation outpatient clinic with stiffness and severe pain after Acinetobacter meningoencephalitis. She had post-repair amputated tongue, hypertonus muscles, spasticity, and asymmetrical posture. After the rehabilitation programs, the pain was decreased to a moderate intensity.

Case discussion: The pain can cause a vicious cycle of pain-induced spasms or spasticity that further increases pain. Multiple organ system impairments can cause the pain. A multidisciplinary team is needed to evaluate and manage the multiple sources of pain. Multimodal rehabilitation interventions consisting of 24-hour postural management, spasticity medication, ultrasound therapy, massage, stretching, and orthosis prescription may help to manage the pain.

Conclusion: Pain after meningoencephalitis can be caused by multiple sources and can be managed by multidisciplinary and multimodality approaches.

The Effect of High-intensity Interval Training on Initial Claudication and Absolute Walking Distance in Peripheral Artery Disease Patient: A Case Report

Arnengsih Nazir — Thu, 27 Jun 2024 12:10:47 +0700

Introduction: Peripheral arterial disease (PAD) causes significant functional impairment due to the presence of intermittent claudication (IC) during activities that caused activity restrictions. Aerobic exercise has been shown to improve walking ability and exercise performance.

Case Description: A 55-year-old man undergoing phase II cardiac rehabilitation (CR) complained about moderate IC during activity and exercise that began from 2 weeks of exercise and increased until the end of phase II CR. Extended CR was given to increase initial claudication and absolute walking distances and physical activity level by giving a hybrid-CR program for 2 weeks. A supervised high-intensity interval training (HIIT) 2 times a week along with resistance exercise and home-based moderate-intensity aerobic exercise 3 times a week were given. After 2 weeks, there was an increase in initial claudication and absolute claudication distance of 23 meters and 91 meters from baseline, consecutively.

Discussion: Aerobic exercise in PAD patients increases walking distance due to improvement in collateral flow, nitric oxide-dependent vasodilatation, inflammatory mediators, endothelial damage, oxygen delivery to working muscles, muscle contraction efficiency, and pain tolerance.

Conclusion: Hybrid-CR with combination of a HIIT and moderate-intensity continuous aerobic exercise improved initial claudication and absolute walking distance in PAD patient.

Preventing Progressivity in Becker Muscular Dystrophy Patient: A Rare Case Report

Agatha Wilda Yoanika Prameswari, Desy Kuniawati Tandiyo — Thu, 27 Jun 2024 00:00:00 +0700

Introduction: Becker muscular dystrophy (BMD) is a genetic disease caused by mutation of the dystrophin gene due to defects in the Xp21.2 chromosome and inherited by X-linked recessive. BMD is a slowly progressive weakness from proximal muscle. BMD patients are rarer than duchenne muscular dystrophy (DMD).

Case Description: An 18-year-old male came with weakness in both legs, mainly at the base of the thigh. The symptoms have been felt for the last three years and progressively for the last two years. He felt a change in walking style and difficulty standing from a sitting position. He denied any family history. Examinations found increased creatine kinase (CK) and electromyography (EMG) showed myopathy in the right femoral nerve. Patient took vitamins daily, done exercise therapy and neuromuscular electrostimulation (NMES) once a week.

Conclusion: Diagnosing BMD is not only from history taking and physical examination but also necessary to consider CK levels and myopathy on EMG, even though genetic testing or muscle biopsy could not be done. Until now there is no guideline related to BMD therapy programs, further research is expected to discuss BMD therapy program in detail.

Cardiac Rehabilitation in Post COVID-19 Patients with Cardiovascular Diseases Complipication: Review Article

Thu, 27 Jun 2024 12:26:24 +0700

Abstract

Introduction: The outbreak of COVID-19 has been linked to an increased risk to heart health, emphasizing the significance of Cardiac Rehabilitation (CR) in tackling these concerns. This review is intended to improve comprehension of the effects of COVID-19 on cardiovascular health and to assist healthcare providers in their care of patients.

Methods:This study employs a comprehensive literature review covering 2019 to 2021, using keywords "Sars-Cov-2" OR "COVID-19" AND "Cardiovascular Diseases" AND "Cardiac Rehabilitation" across various databases. After screening, 321 articles yielded 32 studies for the pooled analysis.

Results: During the outbreak, 14.4% of the individuals developed acute cardiovascular issues, with a mortality rate ranging from 5.6% to 10.5%, surpassing the seasonal flu mortality rates. Patients post-COVID-19 exhibit similar clinical manifestations, necessitating rehabilitation to enhance their quality of life and prevent future complications. Amidst the pandemic, cardiac rehabilitation centers have shifted to virtual or telemedicine rehabilitation owing to interruptions in regular services.

Discussion: COVID-19 commonly triggers myocarditis, heart failure (HF), arrhythmias, and venous thromboembolism (VTE). Pre-hospital diagnostics and post-discharge follow-up via telemedicine rehabilitation present effective strategies for managing patients with cardiovascular disease (CVD), offering additional clinical insights for cardiologists to diagnose and differentially diagnose patients without in-person consultations.

Conclusion: COVID-19 survivors face potential CVD complications, underscoring the need for CR to improve the quality of life and mitigate CVD risks post-exposure. This rehabilitation approach holds promise for reducing mortality among patients with post-COVID-19 heart disease.

Functional Breathing and Approaches in Pulmonary Rehabilitation: A Literature Review

Siti Chandra Widjanantie, Verial Attamimy, Putu Duhita Ayuningtyas W — Thu, 27 Jun 2024 12:30:29 +0700

Pulmonary rehabilitation is a multidisciplinary approach to improving individuals' quality of life and functional capacity with chronic respiratory diseases. Functional breathing exercises are essential to pulmonary rehabilitation programs, focusing on coordinating respiratory and postural mechanisms to optimize gas exchange, reduce dyspnea, and improve exercise tolerance. This paper discusses the importance of functional breathing exercises in pulmonary rehabilitation and outlines the fundamental principles and techniques used in their implementation.

Keywords: Pulmonary rehabilitation, Functional breathing, Chronic respiratory diseases, Exercise tolerance, Dyspnea, Gas exchange.