Scientific Research Journal of India SRJI Complete Vol-1 2012 All Issues

THE COMPLETE VOLUME 1
ALL ISSUES
YEAR - 2012
SCIENTIFIC
RESEARCH
JOURNAL
OF INDIA
Vol 1 ● No. 1 ● Year: 2012 ISSN: 2277-1700
Scientific Research Journal of India

(SRJI)
Scientific Research Journal of India ( SRJI )

Dr.L.Sharma Campus, Muhammadabad Gohana,
Mau, U.P., India. Pin- 276403
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Vol.1 ● No.1 ● 2012 Scientific Research Journal of India 1
Table of Content
● Editorial 2
● Vermicompost: a source of soil fertility management in organic
(Agriculture ) 3
farming
● Growth Status among Females of Solan District of Himachal (Anthropology ) 10
Pradesh
● Exploration of the History of Physiotherapy 19
● Effectiveness of Proprioceptive Training over Strength Training
(Physiotherapy )
in Improving the Balance of Cerebral Palsy Children with 23
Impaired Balance
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Editorial
Dear Readers,
It is my immense pleasure to present the first issue of the first volume of the Scientific
Research Journal of India (SRJI). This journal is the official organ of Dr. L. Sharma Medical
Care and Educational Development Society. Scientific Research Journal of India is a
Multidisciplinary, peer reviewed and open access Journal of science. The scope of this
journal is therefore necessarily broad to cover recent discoveries in structural and functional
principles of scientific research. It encourages and provides a forum for the publication of
research work in different fields of pure and applied sciences. The Journal will publish
selected original research articles, reviews, short communications and book reviews in the
various fields of science like Botany, Zoology, Medical Sciences, Agricultural Sciences,
Environmental Sciences, Natural Sciences, Anthropology and any other branch of related
sciences. The Journal will be regularly published and issued quarterly. We shall also publish
special issues based on specific themes at the suggestion of the executive committee of Dr. L.
Sharma Medical Care and Educational Development Society and members of editorial of
SRJI.
I hope you shall appreciate our effort.
Dr. Popiha Bordoloi, Ph.D.

Vermicompost: A Source of soil fertility management in organic farming
P. Bordoloi*, A. Arunachalam**, K. Arunachalam*** & S.C. Garkoti****
Abstract: Use of vermicompost in crop field can reduce the cost of cultivation by replacing
chemical fertilizer and it maintains sustaimentnable agriculture by improving soil texture and
its enrichment. Vermicompost can convert waste in to money, so, it is rapidly becoming a
growth business with an overall mandate of organic farming. Most of the farmers of India in
general and Arunachal Pradesh in particular are marginal and poor. For them it is sometimes
not possible for construct a cemented vermicomposting tank for producing vermicompost due
to lack of Government subsidy. A low-cost bamboo beam vermicomposting unit was prepared
and productivity was analyzed. The economics of bamboo beam vermicomposting unit was
worked out and compared with that of the cemented tank vermicomposting unit as collected
from different sources. In bamboo beam vermicomposting unit, the cost of production of one
quintal vermicompost for first year was Rs. 79. For second year it was Rs. 6 and for the third
year it was Rs. 14.40. In cemented tank vermicomposting unit the cost of production of one
quintal vermicompost for first year was Rs. 632 and for second year onwards it was Rs. 10.
Thus it is concluded that low-cost vermicomposting technology can be used as a source of
income generation for the rural people by recycling and utilizing the locally available
biodegradable wastes.
Key words: Vermicomposting technology, biodegradable waste, Arunachal Pradesh.
Introduction
Arunachal Pradesh is a ‘biodiversity rich cropped areas are also available annually,
hot spot’ in the Indian Eastern Himalayas. which are usually burned for crop
The agro climatic condition and variation cultivation in the subsequent years. The
in elevation and latitude caused the estimated amount of agricultural crop
occurrence of different and distinct waste in Arunachal Pradesh was 261865
vegetation types of this region. Huge tonne (t) per year which could be
amount of agricultural crop residues, weed harvested from the cereals and legumes
biomass from both cropped and non- cultivated. In addition, a substantial
amount of wastes are also arising from overcome productivity crisis in agriculture
livestock. For instance, about 2221440 t of and play a multifaceted role in the
wet dung per annum, and 1382520 t of improvement of soil texture through its
urine per annum were arising from total influence in soil pH, as agent of physical
number of livestock available (Bordoloi et decomposition by promoting humus
al., 2007). In all, these agro-wastes could formation by improving soil texture and its
be utilized successfully for compost enrichment (Venkateshwarlu, 1995).
preparation and recycled for integrated Desai (1993) reported that by using
nutrient management for enhancing vermiculture the cost of production could
production and maintaining productivity. be substantially reduced by way of
While using organic materials as replacing chemical fertilizers.
manures for crop production, the farmers In totality, vermicompost can
are faced with the problems of organic convert waste in to money, so, it is rapidly
materials being bulky, with a low nutrient becoming a growth business with an
content in relation to their volume, and overall mandate of organic farming. Most
being often messy and has bad odour. of the farmers of India in general and
Therefore there is a need to develop an Arunachal Pradesh in particular are
eco-friendly and appropriate technology to marginal and poor and may not afford to
maximize economic value of nutrients of construct cemented vermicomposting tank.
agro-waste for sustainable utilization. So, it is envisaged to have a low- cost unit
Decomposition reduces much of organic for the resource poor farmers of this
substances due to physical breakdown of region. By considering all these views, for
substrate, leaching of soluble materials, maintaining sustainable crop production as
and catabolism or oxidation (Seastedt, well as to reduce the cost of fertilizer
1984). Conventional methods of application an attempt was made to
composting takes relatively higher time prepare a non-tank vermicomposting unit
and produce low quality manure. Use of (bamboo beam) by utilizing locally
earthworm for degradation of organic available materials and resources. It can
waste and production of vermicompost is also be viably used as a source of income
becoming popular and is being generation for the rural people by utilizing
commercialized. Use of vermicasting as locally available biodegradable waste
biofertilizer can be one of the measure to materials.
Material and Methods

An experiment was conducted to evaluate Industries Commission (KVIC), Midpu,

a low-cost bamboo beam structure for Arunachal Pradesh. A total of 1500
vermicompost preparation. The specific earthworms (750 earthworms; size < 0.7 g,
objective of the study being to test the 750 earthworms size > 0.7 g) was
efficiency of some plant waste material as inoculated for each bed and the bed was
a source of compost as well as to test the covered by a gunny cloth. Moisture was
efficiency of methods of compost maintained at 40-50%. Each of the
preparation and also to develop a low-cost, treatments was replicated three times to
eco-friendly bio-composting technique. reduce the error of measurement of
Three types of compost namely particular parameters. Among all,
simple compost, enriched compost and vermicompost was found more nutritious,
vermicompost were prepared from easily less time consuming and more productive.
available agricultural waste i.e. rice straw, The structure of bamboo beam unit and
weeds from rice field and kitchen waste. different stages of vermicomposting are
Cow dung was mixed for all the compost presented in Figure 1.
in the ratio of 1:1 (by weight). Bamboo The economics of bamboo beam
beam of size 1m×1m×0.5 m were vermicomposting unit was worked out and
prepared. The beam was covered with compared with that of the cemented tank
polyethylene sheet to check the nutrient vermicomposting unit as collected from
loss and to provide proper temperature for different sources. The cost of cemented
quick decomposition. In vermicomposting, tank vermicomposting unit was calculated
after 25 days of decay the partial by personal observation and by having
decomposed materials were transferred to interviews with different farmers which
the vermicomposting bed of size have their own vermicomposting units
2m×1m×0.3 m for inoculation of prevailing in Papum Pare district and from
earthworms. The identified suitable strain the Department of Agriculture, Govt. of
of earthworm i.e. Eisenia foetida (Sav.) Arunachal Pradesh. The net cost of
was collected from Multi-Disciplinary production per kilogram per year was
Training Centre (MTDC), Khadi Village calculated.
Results and Discussion
For construction of low cost bamboo beam takes very low-cost compared to a concrete
vermicomposting unit of 1 tonne capacity tank. The cost of production of one tonne
per harvesting a total of 60 piece bamboos vermicompost can be reduced by 87.5 % in
was needed for construction of shed and the first year. For second year cost of
bamboo beam, which was cost around Rs. production could reduce to 40%. Third
600. The total cost of thatch and polythene year it needs some what more that is 44%
sheet comes around Rs. 600. Labour cost more cost of production due to repairing of
for construction of the unit was Rs. 350. bamboo beam and bamboo shed for
The initial cost of earthworm was Rs. production of vermicompost for
2000. The total cost including maintenance subsequent years. On an average, the
and packaging for first year was Rs. 3950. production cost of one quintal
For second year it was Rs. 300 and for vermicompost in bamboo beam was Rs.
third year it was Rs. 720. In one year 5 33.13 and in cemented tank it was Rs. 217
harvesting was done, so total of 50 q of in first three years.
compost was harvested from the unit. Net Low cost vermicomposting
profit for first year was Rs. 31,050, for technology can help the marginal and
second year it was Rs. 34,700 and for third resource poor farmers of the North East
year it was estimated Rs. 34,280. In the India. The cost of cultivation of crops can
first year, the cost of production of one also be reduce by popularizing
quintal vermicompost was Rs. 79, for vermicomposting technology by replacing
second year it was Rs. 6 and for the third the need of chemical fertilizers. Most of
year it was Rs. 14.40 (Tables 1 and 2). the peoples of North East India depend on
The construction cost of one tonne Agriculture. Vermicompost not only helps
capacity per harvesting cemented tank type to increase the productivity of crops but
of vermicomposting unit was Rs. 31,600. also helps as income generation for the
An expenditure of Rs. 500 was required youth of North East India. By utilizing
for maintenance and packaging from the locally available resources and waste
second year onwards. Thus the production material available by their own, the
cost for one quintal vermicompost was Rs. farmers can construct a small
632 in the first year. And from second year vermicomposting unit and can utilize it as
onwards it was Rs. 10 only (Tables 3 and a source of income generation. Now a
4). days, it is a great concern to popularize the
From the data it is seen that non- organic farming. The demands of organic
tank bamboo beam vermicomposting unit,
products are increasing not only in the local market but also in global market.
a b
c d
Figure 1: (a) Bamboo beam structure (partial decomposition tank), (b) Placing of agricultural
waste material in partial decomposition tank, (c) Earth worm collection from rearing bed, (d)
Vermicomposting bed after inoculation of earthworm.
Table 1. Cost of production of non tank vermicomposting unit (bamboo beam)

Parameters Cost
1st year 2nd year 3rd year

Construction of shed (Bamboo 20 pieces 200.00 - 40.00
@Rs. 10 per culm), (Size of shed 14m×16 m)
Bamboo beam 12 numbers (size 1 m ×1m×0.5 400.00 40.00
m), and bed 6 numbers (size 2 m × 1 m × 0.3
m), (Bamboo 40 pieces @Rs. 10 per culm)
Thatch 400.00 - 100.00
Polyethylene sheet 200.00 - 100.00
Man days for construction ( @ Rs. 70) 350.00 - 140.00
Miscellaneous 100.00 100.00 100.00
Cost of earthworm 2000.00 - -
Packaging cost 200.00 200.00 200.00
Sieve 100.00 - -
Total cost 3950.00 300.00 720.00
Cost of production of 1 q vermicompost Rs. 79.00 Rs. 6.00 Rs. 14.40
(Production capacity per harvesting 10 quintal)
Table 2. Production of vermicompost in non-tank vermicomposting unit (bamboo beam)

Production in one harvesting 10q 10q 10q

5 harvesting in one year 50 q 50 q 50 q
Market price for 1 kg Rs. 5.00 Rs. 5.00 Rs. 5.00
vermicompost
Gross income after 1 year Rs.25,000.00 Rs.25,000.00 Rs.25,000.00
Sale of earthworm Rs. 10,000.00 Rs. 10,000.00 Rs. 10,000.00
Gross income after 1 year Rs. 35,000.00 Rs. 35,000.00 Rs. 35,000.00
Net profit Rs. 31050.00 Rs. 34700.00 Rs. 34280.00
Table 3. Cost of production of tank type vermicomposting unit (cemented type)

Parameters Cost

Construction of shed (11m ×3m) 14,000 - -
Construction of tank of size ( 3m× 1m 15,000 - -
×1m) total 3 numbers of tank
Miscellaneous 300.00 300.00 300.00
Cost of earthworm 2000.00 - -
Packaging cost 200.00 200.00 200.00
Sieve 100.00 - -
Total cost 31,600.00 500.00 500.00
Cost of production of 1 q vermicompost Rs. 632.00 Rs. 10.00 Rs. 10.00
(Production capacity per harvesting 10 quintal)
Table 4. Production of vermicompost in tank type vermicomposting unit (cemented type)
Production in one harvesting 10q 10q 10q

5 harvesting in one year 50q 50q 50q
Market price for 1 kg Rs. 5.00 Rs. 5.00 Rs. 5.00
vermicompost
Sale of earthworm Rs. 10,000.00 Rs. 10,000.00 Rs. 10,000.00
Net profit Rs. 3,400.00 Rs. 34,500.00 Rs. 34,500.00
References
-Bordoloi, P., Balasubramanian, D., -T. R. (1984). The role of microearthopods in
Arunachalam, A., Arunachalam, K. and decomposition and mineralization processes.
Garkoti, S.C. (2007). Agricultural waste Annu. Rev. Entomol. 29: 25-46.
management for sustainable crop Production: -Venkateshwarlu, B. (1995). Composing the
A case study in Arunachal Pradesh. decomposed. Indian Silk, September, 1995, 5.
Biodiversity Conservation- The Post-Rio -Desai A. (1993). Congress of Traditional
Scenario in India. Assam University, Silchar. Science and Technology of India, I. I. T.
Seastedt, Bombay, 28 November to 3 December, 1993.
CORRESPONDENCE
*KVK, NRC on Pig, Indian Council of Agricultural Research, Dudhnoi, Goalpara, Assam,
**A.Arunachalam, Division of Natural Resources Management, Indian Council of Agricultural Research, Krishi
Anusandhan Bhavan II, Pusa, New Delhi. ***School of Environment and Natural Resources, Doon University,
Dehra Dun, Uttarnchal, **** School of Environmental Sciences, Jowaharlal Nehru University, New Delhi.
Growth Status among Females of Solan District of Himachal Pradesh
Trinayani Bordoloi*
Abstract: The study aims to see the age related changes in anthropometric and physiological
characteristics and association between adiposity measures and cardiovascular functions
among preadolescent and adolescent females. Growth pattern diverge at time of
preadolescence and adolescence. The present study was conducted by cross-sectional method
among 125 growing Rajput females ranging from 9 years to 16 years of Solan district,
Himachal Pradesh. The adiposity assessed by BMI, WHR, GMT. There is an increase in BMI
with age in the present study and the highest mean value is found at the age of 16. As far as
correlation between cardiovascular functions and adiposity measure are concerned there is a
significant correlation between blood pressure with BMI, GMT and WHR till 12 years, but in
the later years no such pattern was observe.
Key words: Anthropometry, Rajput females, Body Mass Index.
INTRODUCTION
Many changes both structural and functional in Increasing body fatness is accompanied by
the human body are witnessed with the profound changes in physiological functions.
increasing age. These changes could be These changes are to a certain extent, associated
attributed to growth and development which with the regional distribution of adipose tissue.
starts right from conception and also due to Body fatness and its distribution is a useful
environmental conditions such as nutritional epidemiological and clinical marker of health
pattern, physical activity level, health status etc risk among humans. Adiposity is the result of an
experienced by the human body. excessive number and/or size of white adipose
cells. At an individual level, a combination of blood pressure was designed in the Solan
excessive caloric intake and a lack of physical district of Himachal Pradesh.
activity are thought to explain most cases of
adiposity (Lau et al 2007). A limited number of
Materials and methods
cases are due primarily to genetics, medical
reasons, or psychiatric illness (Bleich et al Keeping in mind the objective of the study, data
2008). Anthropometry is the widely accepted on anthropometric and physiological
tool for measures the adiposity of the human. measurements were collected by using cross-
Studies in this regard reveal that BMI, WC, sectional method on 125 preadolescent and
WHR, GMT are the good indicators of the adolescent females in the age groups 9 to 16
adiposity measures of the preadolescent and years of Solan district, Himachal Pradesh. The
adolescent females. According to Barness et al data was collected from the schools in that area;
(2007) adiposity is a leading preventable cause besides some data was also collected from home
of death worldwide, with visits. Age was recorded by the verbal response
increasing prevalence in adults and children, of the subjects. An exhaustive proforma was
and is viewed as one of the most serious public catered to obtain general data of the population
health problems of the 21st century. Excessive under study. The general information collected
body weight is associated with various diseases, from the mating pattern (constructed using
particularly cardiovascular diseases, diabetes maternal and paternal subcastes) established the
mellitus type 2, obstructive sleep apnea, certain fact that the Rajputs follow the rule of caste
types of cancer, and osteoarthritis (Haslam et al endogamy and sub-caste exogamy. Different
2005). It has been very recently observed by body measurements were taken on each
Kotchen et al. (2008) that blood pressure levels individual such as height vertex, body weight,
and the prevalence of hypertension are related to mid upper arm circumference, waist
adiposity, the main components of adiposity circumference, maximum hip circumference,
being BMI, waist/hip ratio, waist/height ratio skinfold thickness at biceps, triceps,
(WHtR) and percent body fat. subscapular, suprailiac, calf posterior, blood
pressure both systolic and diastolic, heart rate,
Taking the above issues into consideration,
pulse rate and breadth holding time. These
the present study on the association of different
measurements were taken according to the
anthropometric parameters of adiposity and
standard recommendations of Weiner and
Lowrie (1981). For assessing the adiposity analyzed by SPSS version 15 evaluation product
measures of preadolescent and adolescent package and excel program itself.
females we have adopted various
anthropometric indices, body mass index, waist-
Results
hip ratio and grand mean thickness and
statistical methods were used to calculate mean, The basic information of the Rajput females of
standard deviation, t-test value and correlation the Solan district, Himachal Pradesh (Table 1)
to draw meaningful conclusions. Mean standard indicates a gradual increase in mean stature,
deviation and t-value were used to assess the body weight with age. The increase in height
changes in successive ages, while an attempt has
vertex from 9 to 12 years was found to be
been made to correlate adiposity measures with statistically significant and increase in body
blood pressure. The analysis of the data was
weight from 13 to 14 years and 14 to 15 years
done by using the Windows Vista basic version
also found to statistically significant. An
of Windows. The calculation of data was done
increasing trend was observed in mid upper arm
in the Microsoft Excel program. The data was
circumference but at the age of 12 years a slight
decreasing pattern was observed.
Table1: Basic information of Rajput females in different age groups.

Variables
Height (cm) Weight(kg) MUAC(cm)
N t- value t-value t- value
Mean±SD Mean±SD Mean±SD
Age(yrs)
9 8 123.0±4.06 18.9±2.90 16.1±1.0
10 8 128.2±4.24 2.488* 22.6±4.75 1.875 19.1±9.1 .937
11 12 135.8±6.78 2.799* 26.7±5.4 1.742 17.4±1.7 .633
12 13 141.0±5.95 2.070* 27.6±6.0 .468 17.0±1.4 .605
13 9 143.9±5.70 1.114 31.0±5.5 1.601 17.3±1.5 .367
14 25 150.0±5.98 2.671* 36.5±5.3 2.679* 19.6±1.6 3.778***
15 16 152.2±10.90 .858 41.5±4.3 3.198** 20.0±3.2 .533
16 34 154.8±5.55 1.108 44.0±5.4 1.624 21.9±1.7 2.728**
*p<0.05 **p<0.01 ***p<0.001
MUAC- Mid Upper Arm Circumference
Table 2 displays a various adiposity measures ratio was found at 10 years (.879cm). The
among Rajput females in different age group. In increase in body mass index and waist
this table BMI and WC showed an increasing circumference and grand mean thickness from
trend with age but WHR and GMT does not 14 to 15, 15 to 16 were found to be statistically
show consistent pattern in subsequent age significant.
groups. The maximum mean value of waist-hip-
Table2: Adiposity assessed by BMI, WHR, WC, GMT
Variables BMI GMT

2
WHR t- WC (cm)
N (kg/m ) t-value t-value (mm) t-value
Mean±SD value Mean±SD
Age(yrs) Mean±SD Mean±SD
9 8 12.6±1.7 .83±.08 50.1±2.6 7.1±1.5
10 8 13.6±2.3 1.188 .88±.21 .614 55.2±11.2 1.246 6.0±1.8 1.312
11 12 14.3±1.4 .842 .85±.13 .325 54.7±4.9 .133 6.9±2.0 1.051
12 13 13.8±1.5 .894 .80±.11 1.183 54.2±7.9 .183 6.9±1.4 .096
13 9 14.9±1.8 1.497 .78±.04 .576 55.4±4.9 .410 6.3±2.2 .738
14 25 16.1±1.5 2.070 .78±.07 .339 59.6±3.8 2.622* 7.2±2.1 1.109
15 16 18.0±2.2 3.198** .77±.06 .566 62.4±3.4 2.351* 7.3±2.2 .077
16 34 18.3±1.5 .529 .74±.10 1.108 84.4±4.9 .069 9.0±2.1 2.556*
*p<0.05 **p<0.01 ***p<0.001

BMI- Body Mass Index
WHR- Waist- Hip Ratio
WC- Waist Circumference
GMT- Grand Mean Thickness
Table 3 displays mean values of various systolic blood pressure and breathes holding
physiological variables along with their standard time. The diastolic blood pressure, heart rate
deviation among Rajput females of different age and pulse rate declined and inclined pattern was
group. An increasing trend was observed in found with advancing age. The increase in
systolic blood pressure from 12 to 13 years was value mean value was found at 13 years of age.
statistically significant and the maximum mean
Table3: The various physiological variables of the subjects.
Vari
able
s
DBP HR PR Breath
SBP
t- (mm/hg) t- (b/min) t- (p/min) holding t-
N (mm/hg) value value value
t-value
Mean±S Mean±S Mean±S time(sec) value
Mean±SD
D D D Mean±SD
Age
(yrs
)
8 100.5±6.7 72.0±6.2 80.6±6.3 77.5±4.8 14.6±3.7
10 8 108.0±11.5 1.60 72.1±7.2 .037 81.5±5.3 .301 76.6±4.4 .378 21.2±7.9 2.114
11 12 109.7±8.3 .384 68.6±6.1 1.187 76.5±7.2 1.674 73.4±7.3 1.105 16.1±5.4 1.764
12 13 105.8±9.6 1.095 66.3±4.6 1.058 81.2±8.1 1.507 78.2±7.2 1.652 21.8±13.1 1.430
2.536
13 9 115.7±8.0 66.2±9.7 .028 77.6±7.0 1.079 75.7±7.2 .816 22.2±10.8 .016
*
14 25 104.4±21.3 1.533 70.4±7.9 1.266 79.7±4.9 .996 75.8±6.1 .054 25.9±11.2 .858
2.452
15 16 112.6±9.6 1.446 72.4±9.3 .742 76.2±3.6 72.9±3.8 1.691 25.8±10.9 .032
*
16 34 114.7±14.4 .527 71.7±7.3 .307 72.9±7.1 1.735 69.2±6.2 2.207* 27.8±11.4 .612
*p<0.05 **p<0.01 ***p<0.001
SBP- Systolic Blood Pressure PR- pulse Rate
DBP- Diastolic Blood Pressure
HR- Heart Rate
In table 4 shows the correlation coefficient of concluded that correlation vary from variable to
blood pressure with body mass index, waist hip variable in all the groups. There is a significant
ratio and grand mean thickness of Rajput correction between blood pressure with body
females in advancing age. In this table mass index, grand mean thickness and waist hip
attempted was made to correlate the various and ratio till 12 years but in later years no such
blood pressure in different age groups and it is pattern was observed.
Table4: Correlation coefficient of blood pressure with BMI, WHR, GMT of the participants.
2
Variable BMI(kg/m ) WHR GMT(mm)
N
SBP DBP SBP DBP SBP DBP
Age(yrs)
9 8 .541 .273 .758* .452 .964** .736*
10 8 .154 .348 .059 .365 .267 .534
11 12 .852** .420 .492 .124 .233 .291
12 13 .617* .535 .039 .042 .571* .576*
13 9 .645 .353 .181 .155 .350 .365
14 25 .131 .040 .173 .061 .048 .051
15 16 .378 .095 .083 .003 .341 .107
16 34 .038 .066 .133 .101 .093 .121
*p<0.05 **p<0.01 ***p<0.001
BMI- Body Mass Index
WHR- Waist- Hip Ratio
GMT- Grand Mean Thickness
Discussion in study conducted by the Abbassi (2000). It is

observed that there is an increase in body weight
The variables considered in this present study from 9 years to 16 years in the present study.
show an increasing trend from 9 to 16 years but The weight of the girls increases with age in
all parts of the body do not grow at the same study the conducted by the Abbassi (2000).
rate. Some body parts or dimensions increase
According to the study conducted by
more than others during the adolescent period
Tyagi et al (2005) the increase in weight with
(Tanner 1962).
age could be due to imbalance of energy in
Mean value of height vertex (stature) favour of energy intake. The circumference
increased among the growing Rajput females of measurement that is mid upper arm
the Solan district of the Himachal Pradesh. circumference show gradual increase with age
Similar findings were observed by Sinha and which indicates musculature development and
Kapoor (2009) where there was an increase in the similar results is found by Nadia et al (2009)
stature of adolescent girls aged 11-17 years. The the mean mid upper arm circumference
height increases in girls from the age of 9 years
(MUAC) and arm muscle area (AMA) for girls faster rate than the numerator of the ratio
gradually increased with age up to 17 years. (Malina, 1974).
BMI and GMT of skinfold do not show With age physiological fitness also starts
steady increase with age. There is fluctuation, stabilizing. But at the present study there is
but a definite trend of increase witnessed would relative decline in heart rate and pulse rate.
entail this due to increase in fat mass. This Comparatively higher heart rate and pulse rate
increase in fatness established the fact that there at an earlier age could be imputed to higher
continues to be increase in fat content in females metabolic rate as well as relatively low blood
throughout life. The fluctuation could be a pressure. Breath holding time displays a steady
reflection of fluctuation for fat stores as fat is increase with age.
depleted incase of faster growth phase (Kapoor An attempt was made to correlate the
et al 1998, Parizkova 1977, Sinha and Kapoor various adiposity measures and cardiovascular
2006). There is an increase in BMI from 9 years functions in different age groups and it was
to 16 years in the present study on preadolescent concluded that the correlations vary from
and adolescent girls of Solan, Himachal Pradesh variable to variable in all the groups. The
with a slight dip from 11 years to 12 years. correlation coefficients reflect an inconsistent
Waist/hip ratio (WHR) is used as index pattern. As far as correlations between
of obesity and regional fat distribution in cardiovascular functions and adiposity measure
epidemiological studies. The decreases of mean are concerned there is significant correlation
of waist-hip ratio in the age group 9 years-16 between blood pressure and BMI, GMT and
years among the growing Rajput females WHR till 12 years, but in later years no such
implies gynoid fat distribution during the pattern is observed. Deshmukh et al (2006)
growing period. During adolescence, there is found strong correlation between systolic blood
widening of the pelvis resulting into broader pressure and diastolic blood pressure with body
hips relative to their waist, hence the mass index and waist circumference in Wardha
ratio decreases as the denominator increases at a district of Central India.
Acknowledgement
Authors gratefully acknowledge Prof. A. K. are indebted to Rajput females of Solan district,
Kapoor, Department of Anthropology, Himachal Pradesh for their cooperation and help
University of Delhi for timely suggestions. They during data collection.
REFERENCES:
Abbassi Val 2000 The National Center for 2006 Canadian clinical practice guidelines
Health Statistics. on the management and prevention of
Barness L A., Opitz J M., Gilbert-Barness obesity in adults and children. CMAJ
E .2007. Obesity: genetic, molecular, and .176(8): S1–13.
environmental aspects. Am. J. Med. Genet. R.M. Malina, 1974. Adolescent changes in
143A(24): 3016–34 size, build, composition, and performance.
Bleich S, Cutler D, Murray C., Adams A.
Human Biology 46:117-131
2008. Why is the developed world obese?
Gharib Nadia M. and Rasheed P. 2009.
Annu Rev Public Health. .29: 273–95
Anthropometry and body composition of
Deshmukh P R., Gupta. S S, Dongre A R,
school children in Bahrain. Ann Saudi Med.
Bharambe M S., Maliye C, Kaur S, Garg B
29(4): 258–269.
S. 2006. Relationship of anthropometric
Parizkova J. 1977 Body fat and physical
indicators with blood pressure levels in
fitness. The Hague, Martinus Nijhiff, B V
Rural Wardha. India J Med Res. 123: 657-
664 Med. Div.
Sinha R and Kapoor S. 2006 Parent-Child

Haslam D W, James W P. 2005.Obesity.
Lancet 366(9492): 1197–209. Correlation for Various Indices of Adiposity
in an Endogamous Indian Population. Coll.
Kapoor S, Patra P K, Sandhu S and Kapoor
Antrop. 30: 291-296.
A K. 1998 Fatness and its distribution
Sinha R and Kapoor S 2009 Gender
pattern among Jat Sikhs. J.Ind. Anthrop. Soc.
difference in fat indices as evident in two
33:223-228.
generations. Anthrop. Anz. 67: 153-163.
Kotchen TA, Grim CE, Kotchen JM,
Tanner J M. 1962. Growth at adolescence,
Krishnaswami S, Yang H, Hoffmann RG,
2nd edition Blackwell Scientific Publication,
McGinley EL 2008. Altered relationship of
Oxford.
blood pressure to adiposity in hypertension.
Tyagi R, Kapoor S, Kapoor A K. 2005.
Am J Hypertens, 21b: 284-289.
Lau D C, Douketis J D, Morrison K M, Body composition and fat distribution
pattern of elderly females, Delhi, India. Coll.
Hramiak I M, Sharma A M, Ur E .2007.
Anthropol..29(2):493-498.
CORRESPONDENCE
*Department of Anthropology, University of Delhi, Delhi-110007, India.
Exploration of the History of Physiotherapy
Krishna Nand Sharma* BPT, MPT (Neuro)
Abstract: Physiotherapy or Physical Therapy or PT, is a conservative science of the treatment

and management after the clinical examination, assessment and diagnosis of the diseases for
restoration of the neuro-musculo-skeletal and Cardio-pulmonary efficiencies, managing pain
and certain integumentary disorders with the help of physical means like radiation, heat, cold,
exercise, current, waves, manipulation, mobilization etc. Many organizations describe
physiotherapy in their ways. This paper explores the historical roots of physiotherapy.
INTRODUCTION
Physiotherapy or Physical Therapy The Maharashtra OT PT Council defines

or PT, is a conservative science of the the physiotherapy as: “ a branch of
treatment and management after the medical science which includes
clinical examination, assessment and examination, assessment, interpretation,
diagnosis of the diseases for restoration of physical diagnosis, planning and execution
the neuro-musculo-skeletal and Cardio- of treatment and advice to any person for
pulmonary efficiencies, managing pain and the purpose of the preventing correcting,
certain integumentary disorders with the alleviating and limiting dysfunction, acute
help of physical means like radiation, heat, and chronic bodily malfunction including
cold, exercise, current, waves, life saving measures via chest
manipulation, mobilization etc. physiotherapy in the intensive care unites,
Various organizations have defines curing physical disorders or disability
the Physiotherapy in their own words. Few promoting physical fitness, facilitating
definitions of them are given below: healing and pain relief and treatment of
The APTA defines the physiotherapy as: physical and psychosomatic disorders
“clinical applications in the restoration, through modulating physiological and
maintenance, and promotion of optimal physical response using physical agents,
physical function. ” 1 activities and devices including exercises,
mobilization, manipulation, therapeutic
ultrasound, electrical and thermal agents Sweden. The Swedish word for physical
and electrotherapy for diagnosis, treatment therapist is “sjukgymnast” (sick-gymnast).
2
and prevention. ” Per Henrik Ling who is called he Father of
Physiotherapists use the patient’s Swedish Gymnastics founded the Royal
history and physical examination to make Central Institute of Gymnastics (RCIG) in
the diagnosis and establish a management 1813 for massage, manipulation, and
plan and in necessity they incorporate the exercise.
results of laboratory, imaging studies and The first use of the word
Electrodiagnostic testing. physiotherapy is found in German
Physiotherapy is concerned with Language as the word “Physiotherapie” in
identifying and maximizing the quality of 1851 by a military physician Dr.Lorenz
life and movement potential within the Gleich.5
spheres of promotion, prevention, Physiotherapists were given
treatment or intervention, habilitation and official registration by Sweden’s National
rehabilitation which encompasses the Board of Health and Welfare in 1887
physical, psychological, emotional, and which was then followed by other
social well being. countries. The word “Physiotherapy” was
The texts reveals that the coined by an English physician Dr.Edward
physiotherapy was rooted in 460 B.C. Playter in the Montreal Medical Journal in
when the physicians like Hippocrates and 1894 after 43 years of the German term
later Galenus who may be believed to have “Physiotherapie”. In his words- “The
been the first practitioners of physical application of these natural remedies, the
therapy used to advocate massage, manual essentials of life, as above named, may be
therapy techniques and hydrotherapy to termed natural therapeutics. Or, if I may be
3
treat people. permitted to coin from the Greek a new
th
In the 18 century, after the term, for I have never observed it in print,
development of orthopedics, machines like a term more in accordance with medical
the Gymnasticon were developed for the nomenclature than the word hygienic
treatment of gout and similar diseases by treatment commonly used, I would suggest
systematic exercise of the joints, similar to the term, Physiotherapy” .6
later developments in physical therapy.4 In the same year four nurses Lucy
The earliest documented origin of Marianne Robinson, Rosalind Paget,
the actual physiotherapy is found to be in Elizabeth Anne Manley and Margaret
Dora Palmerin in Great Britain formed the March 1921 in “The PT Review”. In the
Chartered Society of Physiotherapy.7 same year, Mary McMillan organized the
The first documented professional physiotherapy association named the
institution for Physio- therapy training was American Women’s Physical Therapeutic
School of Physiotherapy at the University Association which is currently known as
of Otago in New Zealand which run an the American Physical Therapy
entry level program in physiotherapy.8 Association (APTA).
After this the next year or in 1914 Primarily in the 1940s the
in United States, Reed College in Portland, treatment consisted of exercise, massage,
9
Oregon, graduated “reconstruction aides”. and traction but later in the early 1950s the
The establishment of the modern Manipulative procedures to the spine and
physical therapy is thought to be in Britain extremity joints began to be practiced
towards the end of the 19th century. The especially in the British Commonwealth
American orthopedic surgeons started countries, in the early 1950s.10, 11
treating the disable children and started
employing women trained in physical
education, massage, and remedial exercise.
It was promoted further during the Polio
outbreak of 1916 and during the First
World War when the women were
working with the injured soldiers.
The first physical therapy research
was published in the United States in
REFERENCES
1. http:/ / www. apta. org/ / AM/ Template. 4. American Physical Therapy

cfm?Section=& WebsiteKey= Association. “ Discovering Physical
2. Maharashtra Act No. II of 2004. Therapy. What is physical therapy ”
Mharashtra Govern- ment Gazzet. 12 Jan (http://www.apta.org/AM/Template.cfm?S
2994. Part 8:5-29 ection= Consumers1& Template=/ CM/
3. Wharton MA. Health Care Systems I; HTMLDisplay. cfm& ContentID=39568).
Slippery Rock University. 1991 American Physical Therapy Asso- ciation.
. Retrieved 2008-05-29.
5. Tertouw TJA. Letter to editor-the origin asp). School of Physiotherapy Centre for
of the term “ Physiotherapy ” . Physiother Phys- iotherapy Research. University of
Res Int. 2006; 11:56-57 Otago. Archived from the original (http:/ /
6. Playter E. Physiotherapy First: Nature’s physio. otago. ac. nz/ about/ history. asp)
medicaments before drug remedies; on 2007-12-24. . Retrieved 2008-05-29.
particularly relating to hydrotherapy. 9. Reed College (n.d.). “ Mission and
Montreal Medical Journal. 1894;xxii:811- History ” (http:/ / www. reed. edu/
827 about_reed/ history. html). About Reed.
7. Chartered Society of Physiotherapy Reed College. . Retrieved 2008-05-29.
(n.d.). “ History of the Chartered Society 10. McKenzie, R A (1998). The cervical
of Physiotherapy ” (http:/ / www. csp. org. and thoracic spine: mechanical diagnosis
uk/ director/ about/thecsp/ history. cfm). and therapy. New Zealand: Spinal
Char- tered Society of Physiotherapy. . Publications Ltd..pp. 16–20. ISBN 978-
Retrieved 2008-05- 29 0959774672.
8. Knox, Bruce (2007-01-29). “ History of 11. McKenzie, R (2002). “ Patient Heal
the School of Physiotherapy ” (http:/ / Thyself ” . World- wide Spine &
web. archive. org/ web/ 20071224020426/ Rehabilitation 2 (1): 16–20.
http:/ / physio.otago. ac. nz/ about/ history.
CORRESPONDENCE
*Academic Chairman: Institute for Health & Wellness
Address: Institute for Health & Wellness, Dr.L.Sharma Campus, Muhammadabad Gohana, Mau, U.P., India.
Pin-276403. Email: [email protected] Cont: +91-9320699167
Effectiveness of Proprioceptive Training over Strength Training in

Improving the Balance of Cerebral Palsy Children with Impaired Balance
Kuki Bordoloi* MPT (Neuro), Nidhi Sharma** MPT (Neuro)
Abstract: This is an experimental study with same subject design. Proprioceptive training and
strengthening exercises is a promising therapy to improve the balance in CP subjects with
impaired balance.The study intended to find out the effectiveness of Proprioceptive training
and strength training exercises on balance of the CP subjects and which of them is more
effective. 30 male or/and female patient of CP with impaired balance will be taken and
randomly divided in to two groups. Group A will be treated with by proprioceptive training
and group B will be treated with strength training for 12 week. Both group will assess with
Timed-Up and Go (TUG) scale and Pediatric Balance Scale (PBS) in starting and at the end of
12 weeks. The result will be statically analyzed using t-test for significance between the two
groups. After a 13-week training period, the ‘t’ test and ‘p’ values were found significant with
values 4.747 & 0.003 for TUG&PBS score respectively stating that there is significant effect
when using Proprioceptive training than giving strength training for improving balance in
geriatric subject with impaired balance. The result states that there is a significant effect when
using Proprioceptive Training than giving Strength Training for improving balance in the C.P.
subjects. So the proprioceptive training should be emphasized in the daily exercise regime of
C.P. subjects to improve their balance.
Key words: Balance, fall prevention, Strength training, Proprioceptive training.
INTRODUCTION
Cerebral palsy is an umbrella term It is caused by damage to the motor

encompassing a group of non-progressive control centers of the developing brain and
[1]
, non-contagious motor conditions that can occur during pregnancy, during
cause physical disability in human childbirth or after birth up to about age
development, chiefly in the various areas three.[4] The motor disorders of cerebral
of body movement.[2] It is a non- palsy are often accompanied by
progressive disorder of motor function.[3] disturbances of sensation, perception,
cognition, communication, and behaviour, ways and to varying degrees in each

by epilepsy, and by secondary individual. Impairments present in children
[5]
musculoskeletal problems. It used to with CP as a direct result of the brain
describe diverse group of disorders of injury or occurring indirectly to
movement, posture and tone due to central compensate for underlying problems
[4]
nervous system insult. In developed include abnormal muscle tone; weakness
countries, the overall estimated prevalence and lack of fitness; limited variety of
of CP is 2-2.5 cases per 1000 live births. muscle synergies; contracture and altered
[34]
The prevalence of CP among preterm biomechanics, the net result being limited
and very preterm infants is substantially functional ability.[10] Other contributors to
higher.[6] the motor disorder include sensory,
cognitive and perceptual impairments.[10]
Balance can be defined as a
complex process revolving the reception Proprioception is a sense produced
and integration of sensory input, and the by the sensory receptors that are sensitive
planning and execution of movement, to to pressure in the tissues that surround
achieve a goal required in upright them.[11] They are also present in the bones
posture.[7] The control of balance requires of the legs, arms or other parts of the body
the integration of information from and these receptors response to stretches of
multiple sensory and motor systems by the the muscle surrounding them and send
central nervous system (CNS).[8] Balance impulse through the sensory nerve fibers
receptors in the inner ear (vestibular to the brain.[11] Decline in dynamic
system) provide information to CNS about position sense is associated with decrease
[9]
the head and body movements. The eye in the balance of C.P. children and this
(visual system) provides input regarding decline in proprioception can be prevented
the body’s orientation and motion within or improved by Proprioceptive training.[12]
the environment.[7] The position and In a study Edward R Laskowski et al
motion sensory of the muscle and joints, (1997) shown that proprioception based
and the touch receptors of the extremities rehabilitation programs improved
(proprioceptive system) send signals objectives measurements of functional
regarding bodily position particularly in status, independent of changes in joint
[7]
relation to the supporting surface. laxity and proprioception can be improved
through Proprioceptive training.[12]
The balance disorder of cerebral
palsy (CP) is expressed in a variety of
Muscle strength is another factor Recent research has focused on muscle

that plays an important role in balance and weakness. ‘Wiley and Damino’ and Ross
[7]
mobility. Muscle weakness can be major and Engsberg’ described muscle is more
problem for many young people with pronounced distally and found imbalance
[7]
cerebral palsy. Training of muscle across joints. Balance control is important
strength and coordination has been for competence in the performance of most
recommended to improve motor function. functional skills, helping a child to recover
[13]
Bobath considered spasticity to be the from unexpected balance disturbances,
main problem in spastic C.P. and either due to slips and trips or to self
suggested that resistance training should induced instability when walking a
be avoided, but Carr stated that it is not the movement that brings them towards edge
presence of spasticity but the negative of their limit of stability.[16]
feature of weakness and loss of skills
Many studies have been conducted
which are the major barriers to improve
to show the individual effect of
function. Many studies have reported
Proprioceptive training and strength
positive result in strength training in
training to improve the balance of C.P.
spastic children.[14] Possible factors
subjects. Hence this studies aims to
interfering with normal gait pattern in
analyze the effectiveness of both treatment
cerebral child includes spasticity, muscle
technique and prove the better
contracture, bony deformities loss of
effectiveness by comparing Proprioceptive
selective motor and muscle weakness.[15]
training and Strength training.
METHODOLOGY
Sample selection Children below 8 years and above 14

The selection criteria are listed below. years, Children with any other
Inclusion Criteria: CP subjects with age neurological impairment, Children with
group of 8-14 years, With normal I.Q. audio visual impairment, Non ambulatory
(assessed by psychologist), Can follow patients.
commands, Both boys and girls subjects,
Measurement tools
CP subjects who had fall at least twice a
day, Subject who scored greater than 20 Timed up and go scale
second in TUG test. Exclusion Criteria:
Timed up and go scale provides a reliable they were referred to physiotherapy

quick screening measure. Many researches department by neurologist.
indicate that most adult can complete the
Method
test in 10 seconds. A score of 11 to 20
seconds are considered within normal limit The children were randomly divided in
for frail elderly or individual with a two groups of 15 children each. All the
disability whereas score over 20 seconds subjects were measured for functional
are indicative of impaired functional balance using Timed Up & Go Test and
mobility. To perform this, the subject is in Pediatric Balance Scale before start the
sitting position and a visible object is training period and at the end of thirteen
placed 3 meter away from the patient. The weeks of training.
subject is instructed to get up and walk
Group A was trained with the
down till the object and return to the seat.
Proprioceptive training whereas the Group
During this task timing is maintained with
B was trained with the Strength training.
a stopwatch and the time taken for it is
recorded. A score greater than 20 seconds Protocol
is associated with high risk in community
Strength training
dwelling older adults.
Berg Balance Scale All the subjects were treated with lower
The Pediatric Balance Scale (PBS), a extremity strengthening exercises using
modification of Berg's Balance Scale, was weight cuff. A standardized weight of one
developed as a balance measure for repetition maximum (1RM) was
school-age children with mild to moderate considered for the subjects. 1RM was
motor impairments.It is used to assess determined before the training for all the
balance and mobility which has 14 subjects.
functional tasks commonly performed in
A repetition of 8 to 15 times were
everyday life with scores ranging from 0-
done for all the strengthening exercises for
4, with a maximum score of 56.
duration of 30 minutes per session; with 5
minutes rest period in between for five
Procedure
days a week and were continued for 13
Patients were selected on the assessment weeks.
and diagnosis of their condition and put on
The following exercises were then
the inclusion and exclusion criteria after
given and it was ensured that the position
of subjects in all form of exercises were kept on the thigh or on the side of the
comfortable. chair, and then the right leg with the
weight cuff was extended slowly in front,
1. Side leg rising
parallel to the floor for a period of 3
Subjects were made to lie in side lying seconds. With right leg in that position, the
position and instructed to abduct the upper foot was flexed so that the toes were
leg tied with weight cuffs slightly about 6- pointing towards head; the foot was held in
12 inches. This position was held for that position for 1-2 seconds. Duration of 3
sometime and then the leg was lowered. seconds was taken to lower the leg back to
Same exercise was repeated with the other the starting position, so that the balls of the
leg. foot rested on the floor again. The same
procedure was repeated with the other leg.
2. Knee flexion exercise
5. Ankle Dorsiflexion
Subjects were made to sit on high chair or
table, the knee was bent slowly as far as Sitting on the chair with back support, the
possible, so that the foot with the weight subject was asked to lift the foot tied with
cuff was bent behind. The subject was a weight cuff so that the toes were pointing
asked to hold the position and then the foot towards the head. Then the subject was
was lowered slowly all the way back asked to hold and slowly return to the
down. The same procedure was repeated original position. The same procedure was
with the other leg. repeated with the other leg.
3. Hip Extension Exercise Proprioceptive Training
Subjects were made to lie on prone Subjects in Group A were given proper
position and one leg with weight cuff was warm up for 5-10 minutes before starting
lifted slowly straight upwards. The subject the treatment in the form of simple
was asked to hold the position and then the stretching (Quadriceps and hamstring
leg was lowered. The same procedure was stretch) and free exercises (knee flexion
repeated with the other leg. and extension in side lying and high
sitting).[63]
4. Knee Extension Exercise
All the proprioceptive exercises
Sitting on the chair with back support, the
were performed for duration of 30 minutes
subject was asked to rest the balls of the
per session; with 5 minutes rest period in
feet & toes on the floor. The hands were
between for three days a week and were 4. To perform one leg standing with
continued for 13 weeks. one foot raised to the back and to
maintain the position for minimum
The Proprioceptive training included the
3 seconds. This procedure was
following exercises
performed with eyes closed also.
1. Stair climbing up and down (a 5. Same exercise as above performed
regular 3 steps staircase). but with one foot raised to the
2. Standing with feet approximately front. This procedure was then
shoulder-width apart and arms performed with eyes closed.
extended out slightly forward 6. Walking heel to toes.
lower than the shoulder, then 7. Rising from a standard chair (4
lifting both heel off the floor and to times) without arm support.
hold the position for 10 seconds,
followed by climbing regular steps Data analysis
staircase. This procedure was Data analysis was performed using the
performed with eyes closed also. Statistical Package for the Social Sciences
3. Standing with feet side by side & (SPSS) for windows version 17 (SPSS
holding the arms in same position Inc., Chicago, U.S.A.). The data were
as described above, one foot is analyzed using parametric (dependent‘t’
placed on the inside of the test and independent‘t’ test) and
opposing ankle and to hold the nonparametric (Wilcoxon Signed Ranks
position for 10 seconds. Followed and Mann-Whitney Test) test to find the
by climbing regular steps staircase. significance of the interventions used
This procedure was performed with within and between the group A and B.
eyes closed also. The significant level set for this study was
95% (p<0.05).
RESULTS & INTERPRETATION:
Thirty Cerebral Palsy patients were part of In Group A, 15 subjects with an

the study. Both the groups (A and B) average age of 12.4 yrs (SD=1.96) and in
included 15 patients each, with 11 male Group B, 15 subjects with an average age
and 4 females in group A and 12 male and of 12.1 yrs (SD=1.79) completed the
3 females in group B. Age group taken study.
was between 8-14 yrs with mean age of
12.33 yrs (SD=1.85).
Table 1.1: Comparison of Gender of patients in both groups
Male Female
Group A 11 4
Group B 12 3
Total 23 7
Table 1.2: Comparison of Mean and SD of Age of Patients in both groups
Mean SD
Male 12.8 1.25
Group A
Female 11.3 3.20
Male 11.8 1.80
Group B
Female 13 1.73
Group A 12.4 1.96
Total
Group B 12.1 1.79
Table 1.3 Descriptive statistics of TUG Tests prior to and post study
Mean N Std. Deviation
TUGAPR 23.667 15 1.799
TUGAPS 19.933 15 1.534
TUGBPR 23.333 15 1.676
TUGBPS 21.000 15 1.414
Table 1.4 Descriptive statistics of PBS Tests prior to and post study
Mean N Std. Deviation
PBSAPR 42.1 15 1.792
PBSAPS 47.3 15 2.086
PBSBPR 43.1 15 1.685
PBSBPS 45.9 15 1.995
Interpretation pre and post test means values for TUG
The table 1.1 states that total 30 patients test It clearly shows that individually both
including 7 females were kept in two Proprioceptive training and Strength
groups A and B. The group A included 11 training produced improvement in
males and 4 females whereas the group B Cerebral palsy patients with respect to
included 12 males and 3 females. Stating TUG test but the improvement in the A
that the mean age of total patients was 12.4 which had had the Proprioceptive training
in group A and 12.1 in group B the table showed more improvement. This is again
1.2 shows the mean age of male and confirmed with the findings of PBS test in
female in group A and the male and table 1.4 which states that although both
female in group B as 12.8, 11.3, 11.8, and the groups showed improvement, the
13 respectively. The table 1.3 shows the group A had better findings than group B.
.Timed Up and Go Test:
Table 2.1 Dependent ‘t’ test performed with the pre & post values of TUG test for
significance within the groups
Paired Differences
95% Confidence
Interval of the
Within Group Difference` T Df P
Std.
Mean SD Error Lower Upper
Mean
TUG A Pre – TUG A Post 3.73333 .88372 .22817 3.24395 4.22272 16.362 14 0.003*
TUG B Pre – TUG B Post 2.33333 .72375 .18687 1.93254 2.73413 12.486 14 0.002*
*-Significant
Table 2.2: Independent ‘t’ test performed with the pre & post values of TUG test for
significance between the groups
Independent Samples Test

t-test for Equality of Means
Levene's Test for
95% Confidence
Equality of
Interval of the
Variances
Between Group Difference
Std.
Mean
F Sig. T Df P Error Lower Upper
Diff.
Diff.
Equal
TUG A-
variances .429 .518 4.747 28 0.003* 1.4000 .29493 .79586 2.004
TUG B
assumed
*-Significant
Interpretation improvement in Cerebral palsy patients

within their group with respect to TUG
The table 2.1 shows that the value of ‘t’ as
test.
16.362 and 12.486 for TUG Test in Group
A and Group B respectively in dependent The table 2.2 shows that the value
‘t’ test. The ‘t’ value is significant at of ‘t’ as 4.747 in independent ‘t’ test. The
p<0.5. Graph 4 representing the mean value of ‘t’ is greater even at p<0.05,
values of Pre and Post values of Timed Up which is significant. Hence there was
& Go test show improvement within the significant difference in improvement
group A and B respectively. Hence between Proprioceptive training and
individually both Proprioceptive training Strength training in Cerebral Palsy
and Strength training produced significant patients with respect to TUG test.
Pediatric Balance Scale test:
Table 3.1: Wilcoxon Signed Ranks Test
Within Group PBSAPR - PBSAPS PBSBPR – PBSBPS

Z -3.442 -3.432
P 0.002* 0.002*
*-Significant
Table 3.2: Mann-Whitney Test
GROUP N Mean Rank Sum of Ranks
A 15 21.97 329.50
PBS B 15 9.03 135.50
Total 30
*-Significant
Table 3.3: Mann-Whitney and Wilicoxon test performed with the pre & post values of
PBS test for significance between the group
Between Group PBS
Mann-Whitney U 15.500
Wilcoxon W 135.500
Z -4.083
P 0.003*
*-Significant
Interpretation: PBS show improvement within the

group A and B respectively. Thus there
The table 3.1 shows that the value of ‘p’
is significant improvement on PBS in
as 0.002 for Group A and Group B
Cerebral palsy patients after
when compared within the group
Proprioceptive training and Strength
respectively. Graph 5 representing the
training within their group respectively.
mean values of Pre and Post values of
The table 3.3 shows that the value between Proprioceptive training and
of ‘p’ as 0.003 and hence significant. Strength training in Cerebral Palsy
Hence we can state that there was patients with respect to PBS test.
significant difference in improvement
Table – 4.1 Mean of improvement in all the parameters between group a & Group B
Parameters Group A Group B
TUG 3.73 2.33
PBS 5.19 2.73
Interpretation:
The above table 4.1 and the graph 6,

clearly indicates that the Proprioceptive
training produced more improvement in
the selected parameters (TUG, PBS)
when compared with Strength training in Graph 2: Comparison of Mean and SD
Cerebral palsy patients. of Age of Patients between both groups
and total.
Graph 1: Comparison of both the

groups and the total on the basis of Graph 3: Comparison of Mean and SD
gender of Patients of pre study values of both groups
Graph 6: Comparison of ‘Mean of

Graph 4: Comparison of Mean and SD Improvement’ in all the parameters
of Pre and Post values of Timed Up & between Group A and Group B.
Go test
Graph 5: Comparison of Mean and SD

of Pre and Postt values of Pediatric
Balance Scale
DISCUSSION:
In this study, better improvements in tool are standard tools to analyze balance.
balance outcome were analyzed using Proprioceptive training exercises were
proprioceptive training and strength given to improve the balance by improving
training. This study was done on 30 CP the decreased sense of proprioception in
children with impaired balance who were older age group where as Strength training
divided in to experimental Group
Group-A was given to improve the balance by
treated with Proprioceptive training and improving the strength of lower extremity
Group-B with Strength training. muscles.
The balance was taken as the The improvements in functional

dependant
endant variable which was measured balance due to Proprioceptive training may
using Timed Up & Go test (TUG) and be attributed to the improvemen
improvement of
Pediatric Balance Scale (PBS). Both this mechanoreceptor activation. Structural
changes in the muscle, bone and joints These results were in accord with
during old age accounts for the decreased Gauchard GC et al (1999) to improve
efficiency of the proprioceptors. balance by proprioceptive training. Studies
Researchers reason that proprioceptive done by Pierre Gangloff et al (2003) also
training can improve the joint and supports our results, which prove that
kinesthetic sensation to a greater extent proprioceptive training exercises, improve
that the falls and risk of fall can be reduced balance in subjects with impaired balance.
among the subjects. This supports the experimental hypothesis
hence the null hypothesis was rejected.
Edward R Laskowski et al also
stated that the decline in dynamic position The result of the present study
sense is associated with decrease in the indicates that effect of proprioceptive
balance of C.P. children and this decline in training had a proven effect over strength
proprioception can be prevented or training. All participants in the
improved by Proprioceptive training.My proprioceptive training group declared that
study confirms the study by Edward R their balance had improved and most of
Laskowski et al (1997) which showed that them were motivated to continue with the
proprioception based rehabilitation training. Hence proprioceptive training
programs improved objectives should be emphasized in the daily exercise
measurements of functional status, regime of CP subjects to improve their
independent of changes in joint laxity and mobility and functional status.
proprioception can be improved through
proprioceptive training. [68]
REFERENCES:
1. Cerebral Palsy. National Center on Baltimore: Paul H Brookes
Birth Defects and Developmental Publishing Co. pp. 246–249.
Disabilities, October 3, 2002
3. Davis DW. Review of cerebral
2. Beukelman, David R.; Mirenda palsy, part I: Description,
(1999). Augmentative and incidence, and etiology. Neoratel
Alternative Communication: Netw 1997; 16(3): 7-12.
Management of severe
4. “Cerebral Palsy – Topic
communication disorders in
Overview”.
children and adults. Pat (2 ed.).
http://children.webmd.com/tc/cereb
ral-palsy-topic-overview. Retrieved 12. Edward R.Laskowski, MD; Karen

2008-02-06. newcomer-Aney, MD; Jaysmith,
MD.Refining rehabilitation
5. Anonymus (2007). “Definition and
withproprioceptive training:
classification of cerebral palsy, Feb
expecting return to play; The
2007”. Developmental medicine
physician and sports medicine;
and child neurology 49 (8): 8.
1997 Oct;Vol.25, No. 10.
6. Vincer MJ, Allen AC, Joseph KS, 13. C Andersson et al. Adults with
et al. Increasing prevalence of cerebral palsy: walking ability after
cerebral palsy among very preterm progressive strength training.
infants: a population-based segunda-feira, 10 de maio de 2010
study. Pediatrics. Dec 2006;118(6): 14. Kramer JF, MacPhail HEA.
e1621-6. Relationships among measures of
7. Darcy A Umphred. Neurological walking efﬁciency, gross motor
Rehabilitation. Mosby ability, and isokinetic strength in
Publications. Fourth edition. 2001. adolescents with cerebral palsy.
8. Balance Procedures Manual, Pediatr Phys Ther 1994; 6:3 Á/8.
National Health and Nutrition 15. Phil Page.Knee osteoarthritis:
Examination Survey, Inhanes, May strength training for pain relief and
2001 functional improvement; ICAA
9. Textbook of Medical Physiology. Publication, Vol.1 No.6, September
Arthur C. Guyton, John E. Hall. 2003.
10th Edition. ISBN: 0721602401 16. Mutch LW, Alberman E, Hagberg B,
10. Margaret J. Mayston. People With Kodama K, Velickovic MV. (1992).
Cerebral Palsy: Effects of and Cerebral palsy epidemiology: where
Perspectives for Therapy. Neural are we now and where are we going?
Plasticity. Volume 8, No. 1-2, 2001 Developmental Medicine and Child
11. Vestibular Disorders Association. Neurology 34: 547-555.
Official Website. Retriebed on
10/6/2011
CORRESPONDENCE:
*Neuro-Physiotherapist, GNRC, Guwahati, Assam. Email: [email protected] Cont: +91-8822485959.
**HOD, Dept of Physiotherapy, AIER, Ghaziabad, U.P., India
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Index
Editorial Dr. Parismita Bordoloi 3

Growth in Cerebral Palsy Children
Parmar Sanjay T,
between 3-13 years in Urban Dharwad, 5
Nayana A. Khobre
India
Correlation of Balance Tests Scores With
Sunita Yadav, Physiotherapy
Modified Physical Performance Test In 12
Deepti Dhar
Indian Community-Dwelling Older Adults
Safety Positions for Healthy Sex Following
B.Arun 31
Back Pain
Reduced Instruction Set Computer (RISC) Thanigaivel.V,
Computer
32bit Processor on Field Programmable V. Subramanian, 36
Science
Gate Arrays (FPGAs) Implementation K. Priyadharsan
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Editorial
Dear Readers,
I am very pleased to present the second issue of the Scientific Research Journal of
India (SRJI). This multidisciplinary and open access Journal of science is the official organ
of Dr. L. Sharma Medical Care and Educational Development Society. The previous issue
had covered three disciplines of science Agriculture, Anthropology and Physiotherapy. In this
current issue we are covering two branches of science- Physiotherapy and Computer Science
with total 4 papers. I would like to mention that this journal is intended to publish selected
original research articles, reviews, short communications and book reviews etc. in the various
fields of science like Botany, Zoology, Medical Sciences, Agricultural Sciences,
sciences and we’ll be more than happy to recognize any of your works in these field too.
Wish you a happy reading.
Regards,
Dr. Popiha Pordoloi. Ph.D.

Growth in Cerebral Palsy Children between 3-13 years in Urban Dharwad,

India
Parmar Sanjay T.*. MPT (Paediatrics). Nayana A. Khobre**. MPT (Paediatrics).
Abstract: Background & Objective- Cerebral palsy is defined as a group of non-progressive

disorders of movement or posture due to a defect or lesion of the immature brain. The
incidence of cerebral palsy is 2-2.5 cases in every 1000 live births. Cerebral palsy is frequently
associated with poor growth and children with cerebral palsy tend to be shorter and lighter
than their normal counterparts. Our objective of the study is to find out growth in cerebral
palsy children. Method - A sample size of 100 children with cerebral palsy of either gender
from 3-13 years were assessed for body mass index, growth of children with cerebral palsy was
found out. The outcome measures Child Developmental Care/National Health Center Statistics
growth charts (CDC/NHCS). Results - Statistical analysis was done with statistical software (n
Master 1.0). Data analysis and results showed no statistical significance growth found in
children with cerebral palsy. The study showed that clinically all the children with cerebral
palsy had low growth when assessed on CDC/NHCS growth charts. Interpretation and
conclusion - The children with cerebral palsy had low growth compared with the other
counterparts of same age group.
Key words- Growth, Cerebral Palsy.
INTRODUCTION
Cerebral palsy (CP) is defined as retardation, speech and language and oral-
“umbrella term covering a group of non- motor problems. The etiology of CP is
progressive, but often changing, motor very diverse and multi-factorial. The
impairment syndromes secondary to causes are congenital, genetic,
lesions or anomalies of the brain arising in inflammatory, infectious, anoxic, traumatic
the early stages of its development”. and metabolic. The injury to the
Cerebral palsy is in variably associated developing brain may be prenatal, natal or
with many deficits such as mental postnatal1. The incidence of cerebral palsy
is 2-2.5 cases in every 1000 live births. the incidence of malnutrition in children
There are an estimated 4-5 million children with cerebral palsy6.
and people in India with cerebral palsy2. A study done on incidence of
The incidence of malnutrition in malnutrition in children with cerebral
individuals with cerebral palsy is a palsy tells about feeding problem are
combination of factors, which directly or usually complicated by the lack of
indirectly result in reduced food and awareness of parents of incidence of
nutrient intake3. Feeding problems are not malnutrition in cerebral palsy children.
easily recognizable in children and in order The main reasons for lack of awareness in
to optimally utilize the impaired feeding parents were illiteracy, misconception
potential in these children, early about the disease and associated
identification of the incidence of complications in cerebral palsy. The
malnutrition in individuals with cerebral psychological impact of having child with
palsy is necessary. It also requires regular severe chronic neurological disease is so
assessment of feeding and nutritional deep that parents do not appreciate the
status and appropriate nutritional feeding problems to the extent they should.
4
rehabilitation . The study done on Growth and
While the prevalence of growth nutrition disorders is common secondary
disorders among these children is health conditions in children with cerebral
unknown, certain observations have been palsy (CP). Poor growth and malnutrition
made. Growth failure has been related to in CP merit study because of their impact
the type of cp-spastic or athetoid and to on health, including psychological and
topographical distribution, and oral-motor physiological function, healthcare
dysfunction also has been associated with utilization, societal participation, motor
5
poorer growth function, and survival. Understanding the
A study done on percent body fat, etiology of poor growth has led to a variety
muscle area and oral motor functions are of interventions to improve growth.
important factors for weight gain and Increased recognition and understanding of
linear growth of children with cerebral neurological, endocrinal, and
palsy. The identification of the nutritional environmental factors have begun to shape
problem has a great potential to help care for children with CP, as well. The
improve weight, muscle mass, decrease investigation of these factors relies on
irritability and circulation in order to halt advances made in the assessment methods
available to address the challenges
inherent in measuring growth in children Children diagnosed with cerebral
with CP. Descriptive growth charts and palsy were assessed for BMI by taking the
norms of body composition provide height and weight of the children. The
information that may help clinicians to child was made to stand on the
interpret growth and intervene to improve Stediometer with the consideration of
growth and nutrition in children with CP. physical disabilities to measure the height
Linking growth to measures of health will and Weight was measured by making the
be necessary to develop growth standards children stand on weighing machine.
for children with CP in order to optimize The outcome measures was
health and well-being. CDC/NHCS growth charts. The growth
was assessed by height in meters and
METHOD weight in kilograms and BMI (Body Mass
A sample size of 100 children with Index) is calculated in weight (in kgs) by
cerebral palsy with either gender from 3- height square (in meters). And BMI
13 years of age was assessed for body percentiles were calculated on CDC/NHCS
mass index. The study was conducted for 1 growth charts.
year in Physiotherapy OPD of SDM
medical hospital Dharwad Karnataka DATA ANALYSIS
India. Ethical clearance is obtained from Statistical analysis was done with
the Institutional Ethical Committee, Shri statistical software (n Master 1.0).
Dharmasthala Manjunatheshwara College descriptive analysis was carried out using
of Medical Sciences and Hospital, prior to mean and standard deviation of mean age,
the commencement of the study. The height, weight, BMI, BMI percentile.
children included in the study were Comparison between variables is done
diagnosed cerebral palsy cases, who were using unpaired t-test. The p-value is
able to stand on stadiometer and weighing 0.5693 which shows that there is no
machine. Children who were un-conscious, significant difference between boys and
unco-operative, who were not able to stand girls.
and unstable Patients were excluded.
Parents of the subjects willing to RESULTS
participate were briefed about the study The table1 depicts the distribution
and how the study would help their of study subjects according to gender and
children.A written consent was obtained different types of cerebral palsy children.
from the parents of the children. It shows mainly spastic cerebral palsy
cases more in the present study which than girls which was not significant. The
includes 3-13years of age group. The table table 5 depicts the children in our study are
2 depicts the mean and standard deviation underweight with 86%.
age of both boys and girls. The table 6 shows that comparison
The table 3, 4, 5 depicts that the of boys and girl children with respect to
mean and standard deviation (SD) values BMI scores by t-test with mean and
of height, weight, BMI and BMI percentile standard deviation where there was no
for different diagnosis of cerebral palsy in significant difference between boys and
which dystonic and diplegic type have less girls.
mean values. And by different age groups
of 3-5years, 6-8 years, 9-11 years, and 12+
years have increasing mean values as per
the age increases. The mean values of
height, weight and BMI is less in boys
ILLUSTRATIONS FOR DIFFERENT POSITIONS

Table 1: Distribution of study subjects according to gender by different diagnosis
Diagnosis Boys % Girls % Total
Ataxic CP 5 71.43 2 28.57 7
Dystonic CP 5 83.33 1 16.67 6
Hemiplegic CP 11 64.71 6 35.29 17
Hypotonic CP 6 100.00 0 0.00 6
Diplegic CP 17 60.71 11 39.29 28
Quadri CP 21 80.77 5 19.23 26
Triplegic CP 8 80.00 2 20.00 10
Total 73 73.00 27 27.00 100
The above table depicts Distribution of study subjects according to gender by different
diagnosis
Table2: Mean and SD total oral motor scores and its dimensions by diagnosis
BMI BMI%
Means Std.Dev. Means Std.Dev.
Diagnosis
Ataxic CP 18.1857 4.9878 63.8571 36.0159
Dystonic CP 14.3333 3.2629 35.1667 47.2035
Hemiplegic CP 15.5706 2.0784 41.0000 34.6717
Hypotonic CP 16.0500 4.2646 42.1667 46.2100
Diplegic CP 15.5429 3.0375 30.5357 35.6282
Quadri CP 16.7615 4.2477 48.6154 39.3732
Triplegic CP 17.3800 2.8197 65.5000 32.2154
All Grps 16.1910 3.5160 43.8200 38.2515
Table 3: Mean and SD total oral motor scores and its dimensions by diagnosis
BMI BMI%
Diagnosis Means Std.Dev. Means Std.Dev.
Ataxic CP 18.1857 4.9878 63.8571 36.0159
Dystonic CP 14.3333 3.2629 35.1667 47.2035
Hemiplegic CP 15.5706 2.0784 41.0000 34.6717
Hypotonic CP 16.0500 4.2646 42.1667 46.2100
Diplegic CP 15.5429 3.0375 30.5357 35.6282
Quadri CP 16.7615 4.2477 48.6154 39.3732
Triplegic CP 17.3800 2.8197 65.5000 32.2154
All Grps 16.1910 3.5160 43.8200 38.2515
Table 4: Mean and SD of Wt, Ht and BMI by age groups

Variables Summary 3-5yrs 6-8yrs 9-11yrs 12+yrs Total
Height Means 97.0000 115.7500 130.1481 145.1250 119.6500
Std.Dev. 10.1612 7.6031 10.5492 7.0887 18.6917
Weight Means 13.2120 21.5031 28.5185 41.5563 24.5330
Std.Dev. 3.2447 5.2859 8.3176 12.2666 11.7800
BMI Means 13.7760 16.1719 16.5222 19.4438 16.1910
Std.Dev. 2.0765 3.0619 2.6963 4.6381 3.5160
The above table depicts Mean and SD of Wt, Ht and BMI by age groups
Table 5: Distribution of samples by BMI category and gender

BMI Male % Female % Total %
Under weight 61 70.93 25 29.07 86 86.00
Normal 9 90.00 1 10.00 10 10.00
Over weight 3 75.00 1 25.00 4 4.00
Total 73 73.00 27 27.00 100 100.00
The above depicts that Distribution of samples by BMI category and gender
DISCUSSION children more in 9-11yrs group mean

In our study the mean age group of value was more as comparative to other
boys population is 7.794 and of girls groups.
population is 8.266 out of the total score The mean values in the different
which showed the mean value more in age variable of our study show different mean
group of 9-11years in total score which values of each type of cerebral palsy
depicts there is no significant difference in relatively quadriplegic and hypotonic
BMI in both male and female population. having lower mean as compared to others
As in 9-11yrs age group 30 children were due to smaller sample size in them for
there and in 12+yrs age group were 15 which no statistical analysis was been
children may be because of number of carried out.
Studies have documented that hemiplegic, support the hypothesis that

growth patterns for patients with cerebral non-nutritional factors play a significant
palsy (CP) are different from those in the role in reducing growth in children with
general population. Patients with CP have CP.
below average weight, linear growth, and A study done on Identification of
muscle mass and fat stores compared with malnutrition in children with cerebral
their peers in the general population. Bone palsy: poor performance of weight-for-
mass density is also reduced, especially height percentiles where explained,
among patients who are non-ambulatory undernourished children with CP have
Poor growth in children with CP changes in body composition and
may be related to nutritional factors, proportion compared with normally
physical factors or factors related to the developing peers. Alterations include
brain lesion itself. Nutritional factors increased total body water, severely
include inadequate dietary intake, depleted fat stores, minimally depleted
secondary to impaired oral motor and muscle stores, severe short stature, and
swallowing competence and poor decreased bone density.
nutritional status and may impact directly
on growth. Physical factors result in CONCLUSION
decreased mechanical stress on bones due All the children with cerebral palsy
to immobility or lack of weight bearing. had lower growth than other peer groups,
Bone growth studies have when they were assessed on CDC/NHCS
suggested that immobilization decreases growth charts, which may be due to oral
bone formation and longitudinal bone motor dysfunction and other factors such
growth and increases bone resorption, as neurological factors and the further
which suppresses certain growth- studies can be carried out by considering
stimulating hormones. Factors related to different types of cerebral palsy with
the brain lesion itself may impact on various other scales and their growth
growth either directly (via a negative pattern to find out what oral motor
neurotrophic effect on linear growth) or dysfunction has effect on growth.
indirectly (via the endocrine system).
Growth differences between impaired and
unimpaired limbs in children with
References
1. Bax MCO. Terminology and 5. Kuczmarski R J, Ogdan C L et al.

classification of cerebral palsy. Advance Data CDC Growth Chart:
Dev Med Child Neurol. 1964; 39; United State, Number 314
295-297. December4, 2000 (Revised). U.S
2. Chitra Sankar, Nandini Mundkar. Department of Health and Human
Cerebral Palsy- Definition, Services, Centers for Disease
Classification, Etiology, and Early Control and Prevention/ National
Diagnosis. Indian J Pediatr .2005; Center for Health Statistics.
72 (10) : 865-868. 6. Incidence of malnutrition in
3. Bell et al. A prospective, individuals with cerebral palsy.
longitudinal study of growth, Available from: http.//
nutrition and sedentary behavior in www.cerebralpalsysource.com/mal
young children with cerebral palsy. nutrition/index.html
BMC Public Health 2010, 10:176. 7. Okeke IB, Ojinnaka NC.
4. Bruce K. Shapiro, Pauline Green, Nutritional status of children with
Jackie Krick, Darlene Allen, cerebral palsy in enugu Nigeria.
Arnold J. Capute. Growth of European journal of scientific
severely impaired children: research 2010; 39: 505-513.
neurological verse nutritional
factors. Dev Med Child
Neurol.1986, 28, 729-733.
CORRESPONDENCE
*Assistant Prof, SDM College of Physiotherapy Dharwad India. **Post graduate student, SDM College of
Physiotherapy, Dharwad India.
Correlation of Balance Tests Scores with Modified Physical

Performance Test in Indian Community-Dwelling Older Adults
Sunita Yadav* MPT (Neuro), Deepti Dhar** MPT (Paediatrics)
Abstract: Background and Objective: There is sufficient evidence which shows significant
relationship between balance tests and other functional tests but there is lack of literature
regarding the relationship between balance tests (BBS, MDRT, BPOMA) and Modified
Physical Performance Test in different age groups of older adults. Design: An Observational
Study Subjects: 58 subjects were divided into three different age groups, having the mean age
of 65.3±3.0 (Group-A), 73.7±2.4 (Group-B), 82.6±1.4 (Group-C), mean height of 161.4±5.6
(Group-A), 164.9±10.2 (Group-B), 160.3±5.9 (Group-C) & mean weight of 68.4±4.8 (Group-
A), 72.7±6.9 (Group-B), 63.6±7.7 (Group-C) were recruited in this study from old age home
and local community. Methods: Subjects in each group performed the tests in the following
sequence: BBS (Berg Balance Scale), MDRT (Multi-Directional Reach Test), Modified-PPT
(Physical Performance Test) & BPOMA (Balance Performance-Oriented Mobility Assessment
of Tinetti) with rest period of 5-10 minutes between each scale. Result: The results suggested
that there was a significant positive correlation between balance tests and Modified Physical
Performance Test in different age groups of older adults. Conclusion: The current study
concluded that Modified physical performance test is a efficient tool to assess static and
dynamic balance and also physical function and ambulation in different age groups of older
adults. It was also observed that out of these balance tests used in the study, MDRT was the
most difficult to understand and perform by subjects above 70 years and the subjects above 80
years found it really hard to understand the procedure.
Keywords: BBS, MDRT, BPOMA, Modified PPT, Balance, Physical Function.
INTRODUCTION
The number of persons above the people at or over the age of 60,
age of 60 years is fast growing, especially constituting above 7.7% of total
in India. India is the second most populous population. Recurrent falls are an
country in the world has 76.6 million important cause of morbidity and mortality
in the elderly and are a marker of poor their likelihood of falls and to enhance
2
physical and cognitive status. physical function.
Impaired balance and physical The Berg Balance Scale was
function are the main causes of fall among developed by Kathy Berg (a Canadian
the older adults. Stability and orientation physical therapist) in1993, as a means of
are to distinct goals of the postural control measuring balance in the elderly.
system. Postural control for stability and Multi-directional Reach Test
orientation requires both perception and (MDRT) is developed by Roberta A.
action. Thus, postural control requires the Newton in 2001. It allows for analysis of
complex interaction of neural and the patient voluntary postural control.
4
musculoskeletal systems. The Performance Oriented
Several researchers show that as Mobility Assessment (POMA) scale was
the age increases, the changes in the neural originally developed by Dr. Mary E.
and musculoskeletal systems disturb the Tinetti and first published in 1986, is a
balance and physical activities.6 As age widely used tool for assessing mobility
increases the physical activities and and fall risk in older people. In this study
physical function also decreases due to balance subscale of Tinetti assessment is
11
decreased muscular power and strength. used to assess the balance of older adults.15
Both balance problems and physical Brown, M, Sinacore, D.R.
inactivity affect the quality of life of older developed the modified physical
adults. Therefore the assessment of both performance test in 2005 to provide more
balance and physical function is necessary focus on gross motor function by
for older adults in order to help establish substituting a chair rise task and a balance
appropriate treatment goals, increase task for the writing and stimulated eating
awareness of fall risk and assign tasks described in the original PPT. The
appropriate assistive device and to tool was more useful in identifying deficits
decrease the disability. Several such in physical function than the self- report
instrument have shown satisfactory comparison measure, the functional status
reliability and validity in identifying older questionnaire. The authors concluded that
people with balance and physical the performance based measure could
functional problems, discriminating older assist in early identification of minor
adults by their needs for different assistive problems in physical functioning, and
device to maintain balance or predicting allow for opportunity for early intervention
for the patients.16
Several researchers found that Ability to walk at least 50 feet before
balancing exercises improve physical sitting to rest; Minimal use of rail or cane
function and previous studies also found while climbing. Exclusion Criteria: Use
significant correlation between balance of any assistive prosthetic device; History
scales and other functional tests.17,18,13,19 of any cardiac problem confirmed by
Therefore it is clear that there is a physician; Any history of fainting spells or
relationship between balance and physical extended dizziness due to unknown
function. reasons History of neurological; vestibular
Yet there is no study to show or auditory deficit confirmed by physician;
relationship between these scales or tests History of any visual disorder which will
in different age groups. Therefore the main not be corrected by optical glasses as
purpose of my study is to find out the confirmed by physician; MMSE score
relationship between balance tests and below 23; History of postural hypotension;
Modified physical performance test. History of recent fractures and severe
Second purpose is, the Modified physical arthritic conditions; History of any major
performance test assesses both balance and surgeries during last 6 month; History of
physical function in older adults no other any previous balance training; Moderate to
tool is required because it measure the severe hypertensions
both static and dynamic balance and also
physical function. It tells about fall risk, Measurement Tools
need of assistance device and functional Berg Balance Scale (BBS)
limitations; additionally it takes less time The BBS was developed to measure
to administer as compared to other scale. balance among older people with
impairment in balance function by
METHODOLOGY assessing the performance of 14 functional
This observational study recruited tasks. The results are based on how long it
58 subjects from old age homes and local takes to complete specific tasks and how
community of Delhi and Dehradun well the tasks are performed. Each task is
meeting the inclusion criteria. Inclusion measured on a five point ordinal scale
Criteria: Age - 60 to 89 year old healthy ranging from 0 to 4 (0 = unable to
subjects; Gender- Both male and female; perform, 4 = independent) so that the
Ability to abduct and flex the shoulder up aggregate score ranges from 0 to 56.
to 90 degrees; Ability to stand for Multidirectional Reach Test (MDRT)
minimum 10 min. without any assistance;
The MDRT is an inexpensive, reliable and Procedure
valid screening tool to measure the limits The subjects were recruited based on
of postural stability in four directions inclusion and exclusion criteria the
(forward, backward, right & left) during subjects of different age groups 60 to 69
standing. The distance of each reach is years of age (Group- A), 70 to 79 years of
measured in centimetres or inches. age (Group- B), and 80 to 89 years of age
Balance Performance Oriented Mobility (Group- C). Subjects in each group
Assessment (BPOMA) performed the tests in a sequence i.e. BBS,
The Tinetti assessment is a physical task- MDRT, Modified-PPT, POMA. The whole
oriented scale which measures the gait and procedure was explained to each subject
balance activities of older adults. In this and the subject signed a consent form
study BPOMA was used to assess the before performing the study. Description
balance of the community dwelling older data was collected which included age,
adults; it consists 9 tasks. 6 tasks are gender, height, weight and number of falls
measured on a three point ordinal scale in the past 6 months. MMSE score was
ranging from 0 to 2 and remaining three also assessed. All subjects were assessed
tasks are measured on a two point ordinal by all four scales or tests in the following
scale ranging from 0 to 1 ( 0 = unable to order BBS, MDRT, Modified-PPT and
perform, 1 & 2 = independent). The BPOMA. All components of each scale
maximum score is 16. were demonstrated to all the subjects and
Physical Performance Test (Modified- one practice session was done for all the
PPT) components of four scales by all the
An objective evaluation of overall physical subjects, after that reading was taken. Each
function was obtained by using modified test or scale was administered by myself.
PPT. The severity of physical frailty in All subjects were offered rest breaks and
physical functioning was assessed using a water during the session and completed the
modified PPT. It consists of 9 tasks; each approximately 60 minute testing protocol
task is measured on a five point ordinal without complaint of fatigue or
scale ranging from 0 to 4 ( 0 = unable to discomfort. The resting period of 5 to 10
perform, 4 = independent) except 7th task minute was given after performing each
(turning 360 degrees) which ranges from 0 scale. As a precautionary measure, blood
to 1 (0 = unsteady, 1 = steady). The pressure was checked prior to beginning of
maximum score is 36. the test session and it was again taken at
the end of the last test performed. One
person was always nearby vicinity of the 1] was calculated. The mean and standard
subject. deviation of balance tests and physical
Data Analysis performance test (modified) of Group – A
The data analysis was done on SPSS 11.5 [Table 2], Group – B [Table 3], & Group –
software. The arithmetical mean and C [Table 4], was calculated. The
standard deviation of age, height and correlation values of balance tests with
weight in demographic data were modified physical performance test of
evaluated. Karl pearson’s correlation test Group – A [Table 5], Group – B [Table 6],
was done to analyse the correlation & Group – C [Table 7], were calculated.
between balance tests (BBS, MDRT & Karl pearson’s correlation test was used to
POMA) with physical performance test find out the correlation between BBS,
(modified) among elderly people. MDRT & BPOMA with PPT (modified) in
Statistical significance level was set at < different age groups of older adults, Group
0.05. The data analysis was done on SPSS – A (60 – 69 years of age), Group – B (70
11.5 software. The arithmetical mean and – 79 years of age), and Group – C (80 - 89
standard deviation of age, height and years of age); these three groups showed
weight in demographic data were significant positive correlation between
evaluated. Karl pearson’s correlation test balance tests (BBS, MDRT & BPOMA)
was done to analyse the correlation with physical performance test (modified).
between balance tests (BBS, MDRT &
POMA) with physical performance test Table 1: Mean and standard deviation of
demographic data
(modified) among elderly people.
Statistical significance level was set at < Group – A
N Mean
0.05.
Age 20 65.3±3.0
Height 20 161.4±5.6
Weight 20 68.4±4.8
RESULT AND INTERPRETATION
A sample of 58 subjects were selected on Group – B
N Mean
the basis of inclusion and exclusion Age 20 73.7±2.4
criteria. Each group of older adults had 20 Height 20 164.9±10.2
Weight 20 72.7±6.9
subjects except Group – C (81-89 years of
age) which has only 18 subjects due to Group – C
N Mean
unavailability of the subjects. The mean Age 20 82.6±1.4
Height 20 160.3±5.9
and standard deviation of age weight and Weight 20 63.6±7.7
height of three Groups A, B and C [Table Table 1 shows mean and standard deviation of
demographic data of different age groups. Group –
(60 – 69 years of age), Group –B (70 – 79 years of Figure 1: Mean and standard deviation of
age) & Group – C ( 80 – 89 years of age). balance tests (BBS, MDRT, & BPOMA)
with modified physical performance test
Table 2: (Group – A) Mean and standard
(modified) of Group A, B and C.
deviation (SD) of balance tests (BBS,
MDRT & BPOMA) and Physical
Performance Test (Modified).
Tests N Mean and SD

BBS 20 54±2.4
FR (MDRT) 20 13.6±2.6
BR (MDRT) 20 11.8±2.6
RR (MDRT) 20 12.5±2.5
LR (MDRT) 20 12.2±3.0
BPOMA 20 14.9±1.9
PPT (modified) 20 31.1±2.5
Table 2 shows mean and standard deviation of

balance tests and modified physical performance Table 5: (Group A) Correlations of
test of Group-A (60-69 Years of age). balance tests (BBS, MDRT, & POMA)
with Physical Performance Test
Table 3: (Group – B) Mean and standard (Modified)
deviation (SD) of balance tests (BBS,
MDRT & BPOMA) and Physical Balance Tests r P
Performance Test (Modified). value value
BBS Vs PPT (modified) .759 .000
Tests N Mean and SD FR( MDRT) Vs PPT (modified) .592 .006
BBS 20 27.7±5.3 BR (MDRT) Vs PPT (modified) .671 .001
FR (MDRT) 20 12.0±3.4 RR (MDRT) Vs PPT (modified) .541 .014
BR (MDRT) 20 9.9±3.9 LR (MDRT) Vs PPT (modified) .518 .019
RR (MDRT) 20 11.2±3.3 BPOMA Vs PPT (modified) .826 .000
LR (MDRT) 20 11.4±4.3
BPOMA 20 12.9±2.2 Table 5 shows correlation of balance tests with
PPT (Modified) 20 27.7±5.3 physical performance test (modified), all the
balance tests show significant correlation except
Table 3 shows mean and standard deviation of right and left reaches which show moderately
balance tests and physical performance test significant correlations with physical performance
(modified) of Group-A (70-79 Years of age). test (modified) of Group – A (60 – 69 years of age).
Table 4: (Group – C) Mean and standard

deviation (SD) of balance tests (BBS, Figure 2: Correlation Graph of Berg
MDRT & BPOMA) and Physical Balance Scale (BBS) and Physical
Performance Test (Modified). Performance Test (Modified) of Group –
A.
Tests N Mean and SD
BBS 20 42.6±3.6
FR (MDRT) 20 5.5±2.2
BR (MDRT) 20 3.2±1.9
RR (MDRT) 20 4.9±2.3
LR (MDRT) 20 4.4±2.2
BPOMA 20 10.5±1.4
PPT (modified) 20 18.0±3.5
Figure 2 depicts correlation between BBS and
Table 4 shows mean and standard deviation of modified PPT. It shows positive significant
balance tests and Modified physical performance correlation in 60-69 years of age group i.e. Group –
test of Group A (80-89 Years of age). A.
Figure 3: Correlation Graph Of Forward Figure 6: Correlation Graph Of Lateral
Reach (FR) of MDRT and Physical Reach (LR) of MDRT and Physical
Performance Test (Modified) Of Group – Performance Test (Modified) of Group –
A. A.
Figure 6 depicts correlation between LR of MDRT

Figure 3 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant
and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group –
correlation in 60-69 years of age group i.e. Group – A.
A.
Figure 7: Correlation Graph of Balance
Figure 4: Correlation Graph of Backward Performance Oriented Mobility
Reach (BR) of MDRT and Physical Assessment (BPOMA) with Physical
Performance Test (Modified) Of Group – Performance Test (Modified) of Group –
A. A.
Figure 4 depicts correlation between BR of MDRT

and PPT (modified). It shows positive significant
correlation in 60-69 years of age group i.e. Group –
A. Figure 7 depicts correlation between BPOMA and
Modified PPT (modified). It shows positive
Figure 5: Correlation Graph of Right significant correlation in 60-69 years of age group
Reach (RR) of MDRT and Physical i.e. Group – A.
Performance Test (Modified) of Group -
A. Table 6: Correlations of balance tests
(BBS, MDRT, & BPOMA) with Physical
Performance Test (modified) of Group - B.
Balance Tests r P
value value
BBS Vs PPT (modified) .944 < .01
FR( MDRT) Vs PPT (modified) .874 < .01
BR (MDRT) Vs PPT (modified) .893 < .01
RR (MDRT) Vs PPT (modified) .826 < .01
LR (MDRT) Vs PPT (modified) .710 < .01
Figure 5 depicts correlation between RR of MDRT BPOMA Vs PPT (modified) .856 < .01
and PPT (modified). It shows positive significant
correlation in 60-69 years of age group i.e. Group – Table 6 shows significant correlation between
A. balance tests (BBS, MDRT & BPOMA) and
modified physical performance test in older adults Figure 10 depicts correlation between BR of
[Group – B (70 – 79 years of age)]. MDRT and PPT (modified). It shows positive
significant correlation in 70-79 years of age group
Figure 8: Correlation graph of Berg Balance i.e. Group – B.
Test (BBS) with Physical Performance Test
(Modified) Of Group – B. Figure 11: Correlation graph of Right
Reach (RR) of MDRT with Physical
B.
Figure 11 depicts correlation between RR of

Figure 8 depicts correlation between BBS and PPT
MDRT and PPT (modified). It shows positive
(modified). It shows positive significant correlation
significant correlation in 70-79 years of age group
in 70-79 years of age group i.e. Group – B.
i.e. Group – B.
Figure 9: Correlation graph of Forward Figure 12: Correlation graph of Left
Reach of MDRT with Physical Reach (LR) of MDRT with Physical
Performance Test (Modified) of Group - Performance Test (Modified) Of Group -
B. B.
Figure 9 depicts correlation between FR of MDRT Figure 12 depicts correlation between LR of

and PPT (modified). It shows positive significant MDRT and PPT (modified). It shows positive
correlation in 70-79 years of age group i.e. Group – significant correlation in 70-79 years of age group
B. i.e. Group – B.
Figure 10: Correlation graph of Backward

Reach (BR) of MDRT with Physical Figure 13: Correlation graph of Balance
Performance Test (Modified) Of Group – Performance Oriented Mobility
B. Assessment (BPOMA) with Physical
Performance Test (Modified) Of Group -
B.
Figure 13 depicts correlation between POMA and Figure 15 depicts correlation between FR of
PPT (modified). It shows positive significant MDRT and PPT (modified). It shows positive
correlation in 71-79 years of age group i.e. Group – significant correlation in 81-89 years of age group
B i.e. Group – C.
Table 7: Correlations of balance tests Figure 16: Correlation graph of Backward

(BBS, MDRT, & BPOMA) with Physical Reach (BR) of MDRT with Physical
Performance Test (Modified) – Group-C. Performance Test (Modified) of Group -
Balance Tests r P C.
value value
BBS Vs PPT (modified) .789 < .01
FR( MDRT) Vs PPT (modified) .822 < .01
BR (MDRT) Vs PPT (modified) .852 < .01
RR (MDRT) Vs PPT (modified) .770 < .01
LR (MDRT) Vs PPT (modified) .752 < .01
B POMA Vs PPT (modified) .651 < .01
Table 7: also shows significant correlation between
balance tests ( BBS, MDRT & BPOMA) and
physical performance test (modified) in older adults
[Group – C ( 80 – 89 years of age)].
Figure 16 depicts correlation between BR of
Figure 14: Correlation graph of Berg MDRT and PPT. It shows positive significant
Balance Scale (BBS) with Physical correlation in 81-89 years of age group i.e. Group –
C.
Performance Test (Modified ) Of Group -
C. Figure 17: Correlation graph of Right
Reach (RR) of MDRT with Physical
C.
Figure 14 depicts correlation between BBS and

PPT (modified). It shows positive significant Figure 17 depicts correlation between RR of
correlation in 81-89 years of age group i.e. Group – MDRT and PPT (modified). It shows positive
C. significant correlation in 81-89 years of age group
i.e. Group – C.
Figure 15: Correlation graph Of Forward
Reach (FR) of MDRT with Physical Figure 18: Correlation graph of Left
Performance Test (Modified) Of Group - Reach (LR) of MDRT with Physical
C. Performance Test (Modified) of Group –
C.
Figure 18 depicts correlation between LR of the functional decline. Balance instability
MDRT and PPT (modified). It shows positive
significant correlation in 81-89 years of age group and physical inactivity in older adults
i.e. Group – C.
contribute to this decline in ADLs
Figure 19: Correlation graph of Balance (activities of daily living). Therefore,
Performance Oriented Mobility
Assessment (BPOMA) with Physical effective balance and functional
Performance Test (Modified) of Group – assessments are needed to document
C.
balance and functional abilities and in this
segment of the older adult population. This
information is critical to the design of all
prevention/reduction programs and to
maintain or improve the quality of life for
these individuals.25
The BBS, MDRT, & BPOMA have
Figure 19 depicts correlation between BPOMA and documented validity and reliability to
PPT (modified). It shows positive significant
correlation in 81-89 years of age group i.e. Group – assess balance abilities. As well as
C. physical performance test (modified) has
DISCUSSION also documented validity and reliability to
Assessing balance and physical assess functional abilities in community
abilities as they relate to falls in older dwelling older adults. Previous researchers
adults is complex due to many social and found significant relationship between
health related issues that may be involved. balance scales (BBS, MDRT & BPOMA)
The geriatric population above 80 years with other functional performance tests;
adults presents a more complicated Barthel mobility subscale, Time up and go
situation due to a sedentary life style, a Test and Physical Performance Test
lower level of function, and the dynamics respectively 13, 25, 26. But there is little to no
of their physical and emotional documentation of relationship between
environments. Any one or combination of three balance scales with PPT (modified).
these factors may lead to a falls at any time Thus this study was done to find out the
because the level of the older adult’s relationship of these three balance scales
performance may not meet the demands of with physical performance test (modified).
the environment or task at hand. The need The clinical trial studied the correlation
to reduce this functional decline is an between balance tests (BBS, MDRT, &
important health care issue. It is important BPOMA) and physical performance test
to identify those factors that contribute to
(modified) among elderly people who number of female subjects are more than
were divided into three age categories. males so it could be the reason for lowest
Berg Balance Scale (BBS) values. Another study found mean values
The last two items of the Berg Balance of BBS in fallers (36.5) and nonfallers
Test are considered the most difficult to (35.7) older adults;25 these values are very
perform. These tasks are: item no. 13 & 14 low as compared to the current study. The
(stand with feet in tandem for 30 seconds, reasons could be one that the mean age of
stand on one leg respectively), One study this study population is 83±8.8 years
found that item numbers 12, 13, & 14 are which shows very older subjects. Secondly
25
the most difficult tasks to perform, but in they examined community dwelling older
the current study only 6 subjects (Group B adults who were home bound and have a
& C) found difficulty to perform the 12th neurological or musculoskeletal diagnosis
task. All the subjects got grade 4 for the that may disturb the balance and contribute
1st, 2nd, 3rd, & 4th components of the to falls . In another study the mean value
BBS. Not one subject reached up to 25cm of BBS is 48.6 and the mean age of this
for the 8th component (Reaching forward study is 74.1± 7.9 years which is
with outstretched arm while standing) of approximately similar to Group-B of the
the BBS. current study. The mean value of BBS of
In the current study the mean values (54, the current study is 49.65 which is slightly
49 & 42, as shown in tables 2, 3 & 4) of more, the reason could be the age
BBS in different age groups are lower difference because the mean age of the
from the findings (55,55; 53,52; & 52,48 Group-B is 73.70 ± 2.4 which shows that
for male and female respectively) of one the subjects were mostly between 71 to 75
study in 3 age groups (60-69, 70-79, & years and the subjects of the above said
34
80+ years). This difference may be due study were mostly between 68 to 81 years,
to age difference. They have given the so this could be the reason for the lowest
average mean of age (69); they did not value of BBS among 254 community-
mention the mean value of age for dwelling older adults.13
individual groups so the subjects of the A study done by Patricia S. Smith found
this study may be slightly younger than my significant relationship between BBS and
study; in this study the mean values for forward reach in post acute stroke patients
females in each age group have lower than (r = 0.78).27 The BBS has also been
males and in the current study the scores of shown to correlate with both the Tinetti
the tests for the females also lower and the mobility index (r = 0.91) and the “get up &
go test” (r = - 0.76).28 A correlation greater groups. It also indicates that there is a
than 0.70 between total BBS and total relationship between age and height with
Fugl-Mayer-Scale (FMS) scores have been performance on the lateral reach test.
18
reported in older adults. The above These results similar to the study who
studies shows correlations between BBS reported that, similar to functional reach
and other functional tests. This current performance is positively correlated with
study also shows significant correlation height and negatively correlated with
between BBS and physical performance age.22 The four heighted persons were
test (modified), [r = 0.759, P = <0.01 present in the current study, the values of
(Group - A); r = 0.944, P = <0.01 (Group - all the components of MDRT were greater
B); ); r = 0.789, P = <0.01 (Group - C); as to these heighted persons as compared to
shown in tables 5, 6, 7 & figures 2, 8, and other subjects. Mean scores on
14 respectively]. The reason of significant performance of the functional and lateral
correlation between BBS and physical reach tests in the present study are lower
performance test (modified) could be one than mean scores reported elsewhere.13,29,
30
that the five components are similar In a sample of 14 community dwelling
between BBS and PPT (modified) and elderly females (age, 70-87 years), a study
secondly both BBS and PPT (modified) reported a mean functional reach of
assess static and dynamic balance and also 26.7±8.9cm.30 In another research, with a
physical activity. larger sample of 254 elderly community-
Multi-directional Reach Test (MDRT) dwelling adults (mean age = 74.1±7.9
In MDRT backward reach is the most years), It was reported a mean forward,
difficult task to perform because most of backward, right and left reach tests scores
the subjects of the Group-C used to take a of 22.6±8.6cm, 11.5±7.8cm,17.5±7.6 &
step behind while performing this reach. 16.8±7.4cm respectively.13 Yet another
MDRT is considered the more time taking study reported mean left and right lateral
test and most difficult to understand by the reach test scores of 21.0±2.5cm and
subjects because the mostly older adults 20.0±0.5cm respectively, from 60 healthy
use the spine not the ankle for the reaches. females over the age of 65 (mean age =
This current study shows there is a 72.5±5.0 years).29 In each of the above
significant relationship between mentioned studies scores were defined as
components (FR, BR, RR & LR) of the mean multiple trials which may reflect
MDRT and physical performance test score inflation due to learning over
(modified) in older adults of different age multiple trials. In contrast, scores in
present study were recorded from a single as shown in table- 1). Another study found
trial. Additionally, subjects used the ankle mean value of 13±2.9 among females
movements rather than spine movements (mean age = 83.8±7.7 years),33 which is
which reflects the negative correlation more as compared to mean value
between age and ankle muscle strength, (10.5±1.4, as shown in table- 4 ) of Group-
sensation and ability to generate large C of the current study, in fact mean age
amounts of force at the ankle joint.31 was similar (82.6±1.3 years, as shown in
One of studies in past have revealed that table- 1 ). The subjects for Group-C were
MDRT demonstrated significant inverse all above 80 and physical frailty
relationships with scores on the time up & component was more among the subjects
go test (TUG): [FR (r = -0.442) BR (r = - of the current study while in the above said
0.333), RR (r = - 0.260), LR (r = - 0.310) study where mean value was 83.8±7.7
which is a functional performance test.13 years, many subjects less than may 80
Similarly current study showed significant years. Hence the balance scores were
correlation between MDRT and modified better for them.
physical performance test which is again a Physical Performance Test (Modified-
functional performance test with high PPT)
validity and reliability. Hence it can be In modified physical performance test, the
said that MDRT also shows good Ist & 2nd tasks were considered the most
correlation with different functional difficult task to perform by the subjects
performance tests. mainly for the Groups B & C. Seven
Tinetti Balance Subscale subjects were using the assistive devices
During the performance of this test, the for the 8th & 9th components (climb one
subjects did not find any difficulty with flight of stairs and climb stairs) of the
any of the tasks in the balance of physical performance test (modified) and
performance-oriented mobility assessment four subjects climbed the stairs by holding
(BPOMA) of Tinetti. the one sided railing.
One study found a mean among the In one study it was found that the mean
community dwelling older women with no value of the PPT (modified) score among
health problems on the balance subset of 27 frail obese older volunteers after
32
12.6±1.7 (mean age = 74.7±6.0 years), treatment was 29.4±2.2 and for control
which is similar to mean value (12.9±2.1, group it was 29.8±2.0.34 Mean age was
as shown in table- 3) of Group-B of the 71.1±5.1for treatment group which
current study (mean age = 73.7±2.4 years, matched the current age of Group – B but
the mean value is lower i.e. 27.6±5.2 as subjects 16 were female. It has been well
shown in table- 3, this difference is may be established that in females balance
due to age because in my study the mean component is affected due to larger body
age for the Group - B is 73.7±2.4, which mass in the upper segment the of body.
shows that the subjects were slightly older The age is an important factor that affects
which reflects the negative correlation both balance and physical function of older
between age and physical function.35 The adults. Declines in standing balance have
mean age of group-A of current study is been attributed to sensory, musculoskeletal
65.2±3.0 which is slightly younger than and cognitive changes, typically in some
the control group (69±4.6) of the above combination as multiple systems fall
study, therefore the mean value for this below minimal functional thresholds.36
group of my study is more and second The results of the balance tests and
reason could be that the subjects were physical performance test (modified) are
obese which also reflects the negative different in different age groups of older
correlation between obesity and physical adults, which proved that the disturbance
35
function. in balance and physical function also differ
Another study found the mean values of in severity (mild, moderate and severe for
physical performance test (modified) in group A, B & C respectively) among
community dwelling older adults. The different age groups of older adults. Thus
mean values of three groups [obese assessment and treatment also differ to
elderly, nonobese frail, and nonobese provide effective evaluation and treatment
nonfrail] were 34.4±0.5, 29.3±0.7 and in different age groups. Additionally safety
15
27.8±0.8 respectively. The second group measures are necessary for the Group – C
of above study matched with Group - B of (80-89 years of age) in the assessment and
the current study in respect similar age, treatment also to prevent fall.
weight and condition but the mean value
CONCLUSION
of physical performance test (modified) is There is a significant relationship between
more than the current study, the reason balance tests and physical performance test
could be that the subjects of my study may (modified) and physical performance test
be more frail and reason could be the (modified) is an efficient tool to assess
larger number of female subject in the static and dynamic balance and also
current study compared to this study, there physical function and ambulation in
both genders were in equal proportion different age groups of older adults. It was
while in the current study out of 20 also observed that out of the these balance
tests used in the study, MDRT was the functional level as well as the balance
most difficult to understand and perform issues in an elderly person rather than
for people above 70 years and subjects giving other tests which are time taking,
above 80 years found it really hard to separately for balance and functional
understand the procedure. According to performance.
this test the subject was supposed to
Limitations
perform movement at the ankle joint but
In the present study, the sample size was
more of trunkal mobility was seen in
small. The sample size of age Group – C
people above 80 years while performing
(81-89 years of age) was relatively smaller
this test. Hence it can be said that MDRT
as compared to other groups. Gait subscale
is not a very feasible test for cheeking
of performance oriented mobility
balance in subjects above 80 years.
assessment is not included in this study.
Clinical significance
Future Research
As the Indian population over the age of
Future study can be done with larger
60 years continues to grow, there will be
sample size to see the results. Future
rise in the level of functional disability and
research is needed to find out the
prolonging health. It is therefore
reliability and validity of modified
imperative that appropriate screening
physical performance test with balance
methods are developed to identify
scales (PPT, MDRT & BPOMA) in
community dwelling elderly individuals
elderly. In my study the value of the left
with functional impairment who should be
lateral reach is more than right lateral
referred for a detailed physical therapy
reach for the heighted person. Future study
evaluation. As we have seen that PPT
can be done to identify that why this
(modified) incorporates all important
difference has come and this difference is
entities of balance and function hence,
significant or not.
simply administering modified physical
performance testing can well define the
References
1. Alexander Kalache, Bruno older people: National/Regional
Lunenfold. Health and men ageing. review of India. Available from:
2001. Available from: www. http://
Who_nmh_nph_01.2.pdf. www.who.int/ageing/projects/SEA
2. Dr. B. Krishnaswamy, Dr. RO
Gnanasambandam Usha. Falls in
3. Christopher M. Fredericks. limited older adults. J Gerontology.

Pathophysiology of the motor 2010;495-502.
systems: principles and clinical 8. Keith smith. Sensory changes:
presentations. F.A. Davis company. Senior series. Available from:
Philadelphia: Jean-Francois Vilain; http:// www. Goldenbuckeye.com,
1996. p. 284. http://senior series.osu.edu.
4. Ann Shumway-cookjorie H., 9. Marjorie H. Woolacott, Ann
Morjorie H.woollacott. Motor Shumway. Cook, Lewis M.,
control theory and practical Nashner. Ageing and posture
applications. 2nd ed. Lippincott control: changes in sensory
Williams and Wilkins: 2001. p. organization and muscular
164-165, 181-182, 222-238. coordination. The international J of
5. Kathryn H. Schmitz, Ann R. ageing and human development.
Cappola. The interaction of cancer 1986;23(2):97-114.
and aging: Estallishing the need for 10. H.J.J.(cojanne) kars, B. Eng., Juha
breast cancer rehabilitation. J M., Hijmans, Jann H.B. Geertzen,
Cancer epidemiol biomarkers prev. Wiebren Zijlsta. The effect of
2007;16(5):866-72. reduced somatosensation on
6. Jan Janseen, sleven B. Heymsfield, standing balance: A systematic
Robert Ross. Low relative skeletal review. J Diabetes Sci Technal.
muscle mass (sarcopenia) in older 2009 July; 3(4): 931-943.
persons is associated with 11. Siobhan M White, Thomas R
functional impairment and physical Wojcicki, Edward mcauley.
disability. J American geriatrics Physical activity and quality of life
society. 2002;50(5):889-896. in community dwelling older
7. David clark, carolynnpattern, adults. J Biomed central ltd.
Kieran F. Reid, Robert J, 2009;7:10.
Carobello, Edward M. Phillips, 12. Lusardi, M.M. Functional
Roger A. Feilding. Impaired performance in community living
voluntary neuromuscular activation older adults. J Geriatric Phys Ther.
limits muscle power in mobility 2004;26(3):14-22.
13. Roberta A. Newton. Validity of Moseia A. The effects of a home-

multidirectional reach test: a based exercise program on physical
practical measure for limits of function in frail older adults. J of
stability in older adults. J geriatric Phys Ther. 2010 April-
Gerontology medical sciences. june;33(2): 78-84.
56A(4);M248-M252. 19. Homjet Tal-Hatu Kolapo, Fashoyin
14. Clinimetric properties of the Oyinlola Funmilayo. Balance
performance oriented mobility retraining in post stroke patients
assessment. J Phys Ther 2006 July using a simple, effective and
1. affordable technique reduction De
15. Kathryn D. Mitchell, Roberta A. L’ equilibre après un accident
Newton. Performance-oriented vasculaire cerebral grace a une
mobility assessment (POMA) technique simple, efficace et
balance scale indicates need for accessible. J American
assistive device. 2006;1(3):183- neurological sciences. 2007; 26(2).
189. 20. Ganvir SD. Assessment of
16. Dennis T. Villareal, Marian banks, functional capacity in elderly
Catheraian Siener, David R. Sina population by elderly mobility
Core, Samuel Klein. Physical scale in wardha. Indian academy of
frailty and body composition in geriatrics. 2008;4:89-97.
obese elderly men and women. J 21. Tm steffen, LA Mollinger. Age-
Obesity A Research J. gender related test performance in
2004;12:913-920. community-dwelling adults. J of
17. Angela Conrad Wooton. An neurological Phys Ther.
integrative review of Tai Chi 2005;29(4):181-188.
research: An alternative form of 22. Patricia S Smith, Judith A
physical activity to improve Hombree, Mary E Thompson. Berg
balance and prevent falls in older balance scale and functional reach:
adults. J Orthopaedic Nursing. determining the best clinical tool
2010 April; 29(2): 108-116. for individuals post acute stroke. J
18. Matsuda, Patricia Noritake, Clinical rehablilitation.
Shumway-Cook,Anne, Ciol, 2004;18(7):811-818.
23. Berg K, Wood-Dauphinu S, patients. J American Heart

Williams J, Gayton D. Measuring Association. 2002;33:1022.
balance in the elderly: preliminary 28. Sabrina E., Trader, Roberta A.
development of an instrument. J Newton, RonitaL., Cromwell.
Phys Ther association. 2001 sept Balance abilities of homebound
10. older adults classified as fallers and
24. Jennifer S Brach, Jessie M nonfallers. J of geriatric Phys Ther.
Vanswearingen, Anne B Newman, 26(3):03.
Andrea M Kriska. Identifying early 29. Duncan PW, Weiner DK, Chandler
decline of physical function in J, Studenskis S. Functional reach: a
community-dwelling older womem new clinical measure of balance. J
: performance-based and self report Gerontol Med Sd. 1990;45:M192-
measures. J American Phys Ther M197.
Association. 2001 Sept 10. 30. DeWaard B, Bentrup B, Hollman J,
25. Teresa Steffen, Megan Seney. Brasseur J. Relationship of the
Test-retest reliability and minimal functional reach and lateral reach
detectable change on balance and tests in elderly females. J Geriatr
ambulation tests, the 36-item short Phys Ther. 2002; 25:4-9
form health survey and the unified 31. Sadashiv Ram Aggarwal, Deepak
Parkinson disease rating scale in kumar. Lower extremity muscle
people with parkinsonism. J Phys strength and balance performance
Ther. 2008 june;88(16):733-746. in Indian community-dwelling
26. Mary Thompson, Ann Medley. elderly men aged 50 years and
Forward and lateral sitting above. Indian J of Phys Ther and
functional reach in younger, occupational therapy. 2007;1(2).
middle-aged and older adults. J of 32. Chiara Mecagni, Janet Pullin
geriatric Phys Ther. 30(2):07. Smith, Kay E Roberts, Susan B O’
27. Hui-Fen Mao, Fing Hsueh, Fei- Sullivan. Balance and ankle range
Fang Tang, Ching-Fan Sheu. of motion in community-dwelling
Analysis and comparison of the aged 64 to 87 years : A
psychometric properties of three correlational study. J of American
balance measures for stroke
Phys Ther Association. 2000 May Physical activity and

30; dehydroepiandrosterone sulphate,
33. Dennist , Villareal, Marian Banks, insulin-like growth 1 and
David R, Sinacare, Catherine testosterone in healthy active
Siener, Sarmuel Klein. Effect of elderly people. J Ageing oxford
weight loss and exercise on frailty journals. 1998;27:745-751.
in obese older adults. Arch Intern 36. Dr. Sandra Brauer, Y Voner Burns,
Med. 2006;166:860-866. Prudence Galley. Lateral reach: a
34. Karen W, Hayes, Marjorie E. clinical measure of medio-lateral
Johnson. Measures of adult general postural stability. J Phys Ther Res
performance tests. Arthritis care Int. 1990;4:81-88.
and research. 2003 Oct
15;49(55):S28-S42.
35. Marc Bonnefoy, Tomasz Kostka,
Marie C. Patricol, Sophic E,
Bethouze, Brono Mathian et al.
CORRESPONDENCE
*Student, Dolphin Institute, Dehradun affiliated to H.N.B Garhwal University, Uttarakhand, India Mob:
08882590557. **Lecturer, Dolphin Institute, Uttarakhand. India
Safety Positions for Healthy Sex Following Back Pain
B.Arun.* MPT, CMPT
Abstract: Sexual rehabilitation is never a part of low back rehabilitation in India. Sex is
enjoyment, which should be liked by both the partners, around the world about eight out of
every 10 people has experiencing back pain at some time in their lives, Back pain could cause
difficulty in day-to-day activities. Crisis on partner’s relationship may occur due to
unsatisfactory sex. India a Cultural Rich & Religious country will posse’s mysterious side on
sex and people live in India have closed mouth attitude on sex. Fear about pain during sex is
the first thing which produces fear on sex. The partners should understand the facts on pain
and accommodate the new positions for happy and healthy sex. Variety of recommended
positions is there which help to alleviate pain and gives good support and satisfaction to both
partners.
Key words: Sexual Rehabilitation, Sex, Low Back Pain, Physiotherapy
INTRODUCTION
Sex is pleasure, it is a wonderful activity for both the partners. Pain in the
feeling experienced by both partners. The back is one of the major causes of it.1
interpersonal relationship between the Sexuality is an integral part of
partners brings a firm emotional bond. normal and healthy relationships. It need
Sexual activity has not only produced by not be the first thing abandoned when you
physical, emotional aspects but also are bothered by a flare-up of Back pain.2
biological aspects in human. The strong Though it is chronic it should not prevent
union between the partners may be one from enjoying this part of the
wrecked due to a variety of causes. One of relationship.
the major causes for the breakage is Low back pain is the most common
unhappiness or dissatisfaction. Pain may musculoskeletal problem encountered by
produce disappointments during sexual most adult population around the world.
Four out of five adults will experience
significant back pain sometime during Literatures supports that the physical
their life. After the common cold, activity during sex produce similar stress
problems caused by the back are the most to back same like lifting, pulling ect.. On
frequent cause of lost work days in adults while performing a vigorous movement in
under the age of forty-five. 3, 7 the pelvic region there is an increased
In the Indian scenario, stress at the back. During anterior tilting of
rehabilitation of back pain concludes when pelvis, the back muscles get compressed
a patient has significant reduction of pain with ligaments and other soft tissues. The
or he has got ability to do all ADL repetitive activity produces more stress to
activities, like day to day activities or the muscles, fascia and bones around the
handling job task ect.. Very few back result in pain.
rehabilitation protocols followed in India People with back pain are usually
focuses on the other parts of rehabilitation. aware which positions could cause pain
Mostly sexual rehabilitation is not the and they are able to find out which
choice of treatment for patient living in positions tend to increase or provoke pain.
India. During vigorous sexual activity there is
Sexual activity is frequently more stress in the lumbar region which can
inhibited by acute pain. Sexual prevent active participation of the
dysfunctions following back pain is the individual and most of the time back pain
common complaint but infrequently ruins their intercourse. A good scheme to
discussed with the therapist. The reasons keep enjoying sex is to choose sensuality
for this closed mouth attitude are multiple. over sexuality.
People who are suffering with it feel that Back pain may ruin sexual life and
they may be the only ones having the may wreck the relationship between the
problem and therefore embarrassed to talk partners. So finding the positions which
about it, even with the doctor or to the help to reduce or minimize pain is
therapist. Some doctors do not feel important for a successful sexual life.
comfortable with the subject, or may not Modified positions are there to reduce
even recognize it as a problem.4 stress in the back and help in safe sex.
Conditions like herniated disk, spinal
WHY PAIN OCCURS DURING SEX? arthritis, & Sacroiliac joint dysfunctions
During the sexual activity between need modification of the positions. 7
the partners there are number of Fear of pain may ruin the sexual
musculoskeletal activity happens. life between the partners. Back pain
doesn’t stop the sexual relationship Apart from it the modified positions will
between the partners. In fact it tells to also help to ease pain.
accommodate the position to get rid of Physical fitness doesn’t mean that
pain. Back pain is more of psychological the partner is able to handle the pain.
than physical. The most part of pain Mental fitness is as important as physical
depends on mental status of the person. fitness. Understanding the problem
between the partners is very important for
HOW TO ASSESS IT? managing for the problem. Having a good
Various Back disability scale has communication and developing a positive
an inclusion of sexual relationship attitude can reduce the anxiety and
questionnaire. Like, Oswestry has one part apprehension between the partners. Sexual
which focuses on sexual relationship. The intercourse provides a natural pelvic tilt
scale by Laumann et al., 2005, has come movement which is to be encouraged to
up with a scale to find out sexual relieve lower back pain. Partners must
dysfunction in males. The scale will be create and use of other sexual techniques
helpful in evaluating the dysfunction. that can spare the back, like touching,
atmosphere creation and oral sex. Create
HOW TO MANAGE IT? an atmosphere that is very romantic and
Learning up a new posture or pain not be rushed, relaxed and peaceful. Begin
relieving methods like massage or ice prior with oral method and followed with
to the sex helps in reducing pain and recommended potions.
stress. Usually people with back pain are
aware of which positions those cause pain RECOMMENDED POSITIONS
and they usually avoid such positions or No single position is good for all.
1
movements. Positions depend on the type and cause of
People with Back pain should take back pain and are best consulted with the
a proper rehabilitation measures so that to rehabilitation staff. Generally
cure pain, there are variety of treatment recommendations include positions like
measures in physiotherapy, no single the Missionary position for both men and
treatment is best for all patients. women. 1
Combination of various treatment If a male partner complains of back
approaches help in regaining the function pain, he can be at the top of women will
as well as reducing the pain in patients. help to reduce stress at back, or man can
lie at the side of woman either on the front
or at the back. If a female partner General advice given to partners are
complains, she can be at the top with placing a towel at the back reduce the
variety of positions like in bed or sitting in lumbar curvature which helps to prevent
5
a chair. pain. People with back pain can be advised
Depending on the type of back on good sex through illustration described
pain, the position alters. For example, by Fahrni in 1976. These illustrations give
patients with annular bulge will have an guidelines to people with back pain.
increase in pain during flexion whereas for
a patient with facet problem pain will
increase with extension movements. There
are no hard and fast rules in dealing pain.
ILLUSTRATIONS FOR DIFFERENT POSITIONS
References
1. Danielle Kloeck, “Sex and Back and treatments”.
pain” Webb Physiotherapists Inc, healthynewage.com, 2011.
http://www.physionline.co.za., 6. Kamiah A Walkier, “Tips for
2010, www.spine-dr.com Better sex....even with back pain”
2. Anthony delitto et al., “exercise www.spineuniverse.com, 2008.
based therapy for Low back pain” 7. Grieves.P, “Common vertebral
Sep 2010, uptodate.com. joint problems, Elsevier, 2003.
3. Jerry corners, MD. “ Sex and Back
pain” Healthy back institute,
www.losethebackpain.com. 2010
4. Dr.Kraus. Back and neck pain,
www. Lowback - pain .com 2008.
5. Louise F. Lynch “Sex and back
pain information-causes, Diagnosis
CORRESPONDENCE
*Vice principal, K.G.College of Physiotherapy, Coimbatore 35. Email: [email protected], Mob:
09994576111.
Reduced Instruction Set Computer (RISC) 32bit Processor on Field

Programmable Gate Arrays (FPGAs) Implementation
Thanigaivel.V*, V. Subramanian**, K. Priyadharsan***
Abstract: This paper concerned with the Reduced Instruction Set Computer (RISC) processor
on a Field Programmable Gate Arrays (FPGAs). The processor has been designed with VHDL,
synthesized using Xilinx ISE 9.1i Web pack, with ModelSim simulator, and then implement on
Xilinx Spartan 2E FPGA that has 143 presented Input/ Output pins and 50MHz clock
oscillator. The test bench waveforms for the different parts of the processor are obtainable and
the system architecture is established.
Key words- Processor, HDL,FPGA, RISC, CPU.
INTRODUCTION
The Computer Engineering is very development board, DIO1, and DIO2
much concerned with the cost and extension boards from Digilent have been
performance of components in the used for the hardware implementation. The
implementation domain. Reduced Web pack from Xilinx and ModelSim has
Instruction Set Computer (RISC) focuses been used for synthesis and simulation.
on reducing the number and complexity of
instructions in the machine.1, 2
Field System Construction
Programmable Gate Arrays (FPGAs) are The RISC processor presented in
growing fast with cost reduction compared this paper consists of three components as
3
to ASIC design. In this paper a low cost shown in Figure .1, these Components are
32bit RISC Processor has been designed the Control Unit (CU), the Data Path, and
and synthesized, the design has been the ROM. The Central Processing Unit
described using VHDL, and some (CPU) has 17 instructions. In the following
components have been implemented and sections we will describe the design of the
4, 5, 6, 7
tested on Xilinx FPGA. Spartan 2E three main components of the processor.
ROM then decoding the parts of the order.
The decoding state will also select the next
state depending on the order; the control
unit will jump to the correct state based on
the order given. After all states of a
running order are finished, the last one will
return to the fetch state which will allow us
to process the next order in the program.
Figure .1 System constructions Figure .2 shows the state diagram for the
control unit.
Plan of the ROM
The central processing unit has a
built in ROM which enables us to program
simple code and execute it. It is a basic
16x32 ROM and it is 32bit allied. The List
of signals in the ROM list.
Address: address sent by the control unit

Data out : data that is contained the given address
Read : signal to enable reading from the ROM Figure 2: control unit Design
Ready : signal to indicate when the ROM is
Design of the Data Path
Ready for reading
CLK : clock signal The Data Path consists of subunits
Reset : Initial reset signal that are necessary for performing all of
arithmetic and logic operations. A Data
Plan of the Control Unit path is a hardware that performs data
The control unit plan is based on processing operations.8, 9, 10, and 11 It is one
allows each state to run at one clock cycle, of two types of modules used to represent
the first state is the reset which is a digital system, the other being a control
initializes the central processing unit unit. The Data path model we designed
internal registers and variables. The consists of the units necessary to perform
machine goes to the reset state by enabling all the operations on the data selected by
the reset signal for a certain number of the control unit. The components include a
clocks. Following the reset state would be Register File, Arithmetic/Logic Unit,
the instruction fetching and decoding Memory Interface and Branching Unit as
states which will enable the suitable shown in Figure 3.The Register File holds
signals for reading order data from the
the table of the 32 general purpose
registers available to the CPU, it has two
output ports (output1, outpu2) and one
input port, also it has a 16 bit bus
connected directly to the Control Unit to
pass immediate data. The ALU design
consists of two input ports and one output
port which mainly performs operations on
two operands. It has a design similar to the
control unit which selects an operation
based on a code given by the ALUCL. The
Figure 3: Data Path
Memory Interface was designed to
RESULTS
accommodate simple load/store operations
There are 5 main signals that are
with the 16x32 memory. The effective
viewed in throughout the simulation. The
address is calculated by adding the content
sim_clock signal is the clock generated for
of the address register and the immediate
the simulation and runs at 50Mhz,
data. The Branch Unit calculates a given
instruction fetch signal shows when the
condition by the control unit and raises a
control unit requests data from the ROM,
branch flag whether the condition is met or
the instruction address 32bit bus is the
not, and if the flag is raised, it sends the
address of the instruction being fetched,
branch address back to the control unit in
the instruction data 32bit bus is the data
order to replace the program counter. The
sent out from the ROM, and the reset state
control lines coming from the control unit
is enabled for 3.5 cycle to give enough
operate all the units in the data path. The
time for all units to reset and initialize,
path starts from the register file that has
after that we can see the first instruction
two output ports which are connected to all
beginning at address 0 is executed
the other units, after that the processing is
followed by all the proceeding instructions
done by one of the other units then finally
until the instruction at address 40 Which is
returned back to the register files input
the shift half word “SHW”.
port using the multiplexer. The signals
used in the data path are forwarded from CONCLUSION
the control unit to each subcomponent as 32bit RISC Process has been
needed. design and implemented in hardware on
Xilinx Spartan 2E FPGA. The design has
been achieved using VHDL and simulated gate in Spartan 2E is 200K Logic Gate,
with ModelSim. Digilent Spartan 2E which was not enough for implementing
progress board has been used for the the whole processor, but parts of the
hardware part. Most of the goals were processor have been implemented and test
achieve and simulation shows that the in a real hardware. Future work will be
processor is working perfectly, but the added by increasing the number of
Spartan 2E FPGA was not sufficient for instructions and make a pipelined plan
implementing the whole design into a real with fewer clocks cycles per instruction.
hardware, since the total accessible logic
References
1. John L. Hennessy, and David A. of a coarsegrain reconfigurable
Patterson, “Computer Architecture coprocessor for a RISC core”, 2nd
A Quantitative Approach”, 4th Conference on Ph.D. Research in
Edition; 2006. Micro Electronics and Electronics
2. Vincent P. Heuring, and Harry F. Proceedings, PRIME, 2006, p
Jordan, “Computer Systems Design 229232.
and Architecture”, 2nd Edition, 6. Rainer Ohlendorf, Thomas Wild,
2003. Michael Meitinger, Holm
3. Wayne Wolf, FPGA Based System Rauchfuss, Andreas Herkersdorf,
Design, Prentice Hall, 2005. “Simulated and measured
4. Dal Poz, Marco Antonio Simon, performance evaluation of
Cobo, Jose Edinson Aedo, Van RISCbased SoC platforms in
Noije, Wilhelmus Adrianus Maria, network processing applications”,
Zuffo, Marcelo Knorich, “Simple Journal of Systems Architecture 53
Risc microprocessor core designed (2007) 703–718.
for digital settopbox applications”, 7. Luker, Jarrod D., Prasad, Vinod B.,
Proceedings of the International “RISC system design in an FPGA”,
Conference on Application MWSCAS 2001, v2, 2001,
Specific Systems, Architectures p532536.
and Processors, 2000, p 3544. 8. Jiang, Hongtu; “FPGA
5. Brunelli Claudio, Cinelli Federico, implementation of controller data
Rossi Davide, Nurmi Jari, “A path pair in custom image
VHDL model and implementation processor design”; IEEE
International Symposium on 10. Lou Dongjun, Yuan Jingkun, Li

Circuits and Systems Proceedings; Daguang, Jacobs Chris, “Data path
2004, p V141V144. verification with System C
9. K.Vlachos, T. Orphanoudakis, Y. reference model”, ASICON 2005,
Papaeftathiou, N. Nikolaou, D. 6th International Conference on
Pnevmatikatos, G. ASIC, 2005, Proceedings, v 2, p
Konstantoulakis, J.A. SanchezP., 906909.
“Design and performance 11. Jiang Hongtu, Owall Viktor,
evaluation of a Programmable “FPGA implementation of
Packet Processing Engine (PPE) controller data path Pair in custom
suitable for high speed network image processor design”, IEEE
processors units”, Microprocessors International Symposium on
and Microsystems 31, 2007, p Circuits and Systems, Proceedings
188–199. v 5, p V141V144.
CORRESPONDENCE
*Centre for Research and Development, PRIST University, Vallam, Thanjavur–613403, Tamilnadu, India. E-
Mail: [email protected]. **Centre for Research and Development, PRIST University, Vallam,
Thanjavur–613403, Tamilnadu, India. E-Mail: [email protected]. ***Centre for Research and
Development, PRIST University, Vallam, Thanjavur–613403, Tamilnadu, India. E-Mail:
[email protected]
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Index
Editorial Dr. Popiha Bordoloi 5
Perception of students for laptop

ergonomics and its use in the learning Mayank Pushkar,
7
centre of Sheffield Hallam University, Shobhit Sagar
U.K.
Effectiveness of Educational Sessions on

B. Sharmila,
Reducing Diabetes in Women with Physiotherapy 23
B. Arun
PCOS— A Pilot Study
Efficacy of McKenzie Approach

combined with Sustained Traction in A.Sridhar,
34
improving the Quality of life following S.Vimala
low Back Ache – A Case Report
Rajeswari Shome, M.
Nagalingam,
Diagnosis of Human Brucellosis by
K. Narayana Rao,
Laboratory Standardized IgM and IgG Microbiology 40
B.Jayapal Gowdu, B.
ELISA
R. Shome,
K. Prabhudas
Study of Non-Isothermal Kinetic of

Austenite Transformation to Pearlite in Metallurgical
Mohammad Kuwaiti 53
CK45 Steel by Ozawa Model Free Engineering
Method
Face Exposure Technology Thanigaivel.V 60

Computer
Technology
Recovery of Decayed Species through K.Priyadharsan,
70
Image Processing S.Saranya
Editorial
Dear Readers,
I am very pleased to present the third issue of the Scientific Research Journal
of India (SRJI). This multidisciplinary and open access Journal of science is the
official organ of Dr. L. Sharma Medical Care and Educational Development Society.
The previous issues had covered three disciplines of science Physiotherapy,
Agriculture, Anthropology and Computer science. In this current issue we are
covering two new branches of science- Microbiology and Metallurgical engineering.
I would like to mention that this journal is intended to publish selected original
research articles, reviews, short communications and book reviews etc. in the various
fields of science like Botany, Zoology, Medical Sciences, Agricultural Sciences,
Environmental Sciences, Natural Sciences, Anthropology and any other branch of
related sciences and we’ll be more than happy to recognize any of your works in
these field too.
Your comments and suggestions are very valuable for us.
Happy Reading.
Regards,
Dr. Popiha Bordoloi,

Editor in Chief
Perception of students for laptop ergonomics and its use in the learning
centre of Sheffield Hallam University, U.K.
Mayank Pushkar. BPT, MSAPT (Musculoskeletal)*, Shobhit Sagar. BPT, MSAPT (Musculoskelatal)**
Abstract: Background and purpose: Laptop ergonomics is one of the most

concerned topics which result in high number of symptoms. The aim of this study is to
find out student’s perception about laptop ergonomics and how to make the learning
centre more laptop friendly. Methodology: A Qualitative survey with questionnaire
consisting of both open and close ended questions was used. 80 volunteer
participants participated in this study. Convenience Sampling was used for the
selection of participants. Qualitative Content Analysis has been used for the analysis
of the data. Results: It was observed that most of the students use laptop but they also
get musculoskeletal problems (Laptopitis) because of the extended use and adopting
improper posture while using laptop. Poor adaptation of posture was mainly because
of unawareness about laptop ergonomics and also because of poor set-up in the
learning centre. Conclusion: Laptop can be used in more friendly way without
causing any discomfort if both the factors (awareness and ergonomics setup) will be
considered. Also the awareness about the laptop ergonomics and proper posture
should be spread among student populations as most of students from other faculties
(0ther than related with health faculty) was not aware about the proper posture and
ergonomics.
Keywords: Laptop Ergonomics, Library Setup, Workplace Ergonomics, Laptopitis/

Laptop Related Injury
INTRODUCTION
Now a days, technological advances such as numbness, swellings, and tingling
use of personal computers directly affect the sensation5.Laptops induced injuries have
life of people1. As per the National Centre become so common that an all-
for Education Statistics (2000), the number encompassing term has been used to refer to
of students using computers has increased them as “Laptopitis”, which includes
by more than 50% between 1985 and 1999 musculoskeletal and vision related
in the United Kingdom alone. With 98% of disorders6. Laptops construction and usage
universities having internet facilities, the result in users assuming improper posture
number of students opting for use of laptops resulting in body discomfort, visual and
to conduct their activities is also mental strains2. Moreover, workstations
increasing2.In fact, 80% of British students configured for laptop computers, unsuitable
own a laptop in which 40% spends 3 – 4 furniture faulty lightings, further contribute
hours daily on internet3. Laptops are widely to the physical injuries resulting from use of
being used by professionals who need to laptops5.
travel and work in different places like Hence, there is a great need to study the
office or college4. This phenomenon is ergonomics of laptops. Laptop ergonomics
occurring largely because of the many is a sub discipline under the broad umbrella
benefits accruing from laptops. Laptop of ergonomics that postulates the optimal
offers high technology performance in a manner of working on laptops and the
compact, light, portable and self-sufficient design of workspaces, where they are used
2
with battery provided . in order to keep related injuries to a
minimum and optimize performance7. This
It may be noted though, that the laptop was study is focused on the views of students
2
not configured for long or constant use . about the laptop ergonomics and how to
However, since they are increasingly modify or redesign the learning centre, so
replacing desktops, students do use them for that laptops can be used in their preferred
extended periods of time. This has resulted way in the learning centre for extended
in a series of illnesses affecting different periods of time without causing any
parts of the body which include pain in the physical discomfort or injury.
neck, upper back, hands and wrists,
LITERATURE REVIEW employers. It was found that laptop users

Few studies have been previously adopt a posture with increased neck,
undertaken on ergonomics related to the use shoulder and elbow flexion but the
of laptops or computers. This report has difference was not significant as compared
tried to discover the perception of to desktop users. Similar results were
participants about laptop ergonomics and observed by Harbinson and Forrester (1995).
their views about the lack of resources in The study concluded that laptop users
learning centre for use of laptop in required an increased forward head
ergonomic way. inclination in order to operate the laptop due
Straker and Harris (2000) have completed a to lack of its adjustability.
mixed study with both qualitative and Gold et al. (2011) quantitatively studied
quantitative data in order to establish the postural characterisation in Laptop users in
physical ergonomics issues associated with non-desk setting with 20 asymptomatic
the use and carry of laptop computers by right-hand dominant participants aged
school children. In total 314 participants between 18 and 25. The selected
aged between 10 and 17 years participated, participants were assessed in 3 postures
and filled the questionnaire in phase 1 of the with two minute typing task followed by 5-
study and 20 participants were observed minute editing task on laptop. The study
using the laptop in various locations in has used MaxMATE motion data analysis.
second phase of study. The result found that It was found that subjects reported greater
the participant's discomforts were resulted intensity of discomfort while using laptop in
from using the laptop in a variety of non- prone lying.
traditional work postures and also depend Price and Dowell (1998) conducted a
on the model of laptop they use and carry. quantitative study on 14 volunteer
The study identified the potential physical participants to evaluate the effect of laptop
implications associated with the use of configuration and external input device on
laptops. posture and comfort of laptop users. Each
Straker et al. (1997a) had studied the participant was asked to work on 6 different
adoptive posture while using laptops and computer configuration and anthropometric
desktops. The study was a cross-over study data and baseline Nordic Discomfort Scale
with 16 participants, who were government was completed before the start of the task.
The study concluded that use of extra to find out the solution so that people can
peripherals in laptop seems to be more use laptop in more comfortable and in their
comfortable and thus decrease the preferred way for prolonged time without
discomfort associated with laptop usage. causing any discomfort. Hence, this study
Kumari and Pandey (2010) have conducted aims to focus on the ergonomics of laptops
a cross-sectional study to analyse the health and what modification can be done in the
problems associated with computer usage learning centre of Sheffield Hallam
and role of ergonomic factors. A total of University, so that students can use their
200 participants were selected by stratified laptop in learning centre in their preferred
random sampling from different IT way without any discomfort.
industries. Close ended questionnaire were Ethical approval was obtained from
used as data collection tool. The analysis of Dissertation Management Group (Sheffield
the data was done by using SPSS software. Hallam University). Participants were given
A standardized Nordic Questionnaire was the information sheet and completion of an
use to assess musculoskeletal problems and anonymous questionnaire was considered as
Zung’s self-rating scale was used to assess consent from the participants.
depression. The study concluded the various
problems associated with laptops or METHODOLOGY
desktops use and also the effects of
underlying factors like- environment, Research Design
lighting and setup of the work place on A Qualitative study design with
laptop ergonomics. questionnaire survey was used to obtain the
Several studies on ergonomic research with student's perception about laptop
desktops while the same cannot be said for ergonomics. A qualitative research is the
laptops, through some studies have best means of generating in-depth ideas and
indicated the development of physical developing hypothesis which may
8
symptoms associated with laptop use. Few eventually decide to test quantitatively . As
of the researches have been done, which the main aim of this study was to gather in-
found the symptoms associated with the use depth information and generate ideas so the
2,4,5
of laptop . As per the researcher’s design of the study was chosen as a
knowledge till now none of the studies tried qualitative study.
Sampling fast method of sampling if the population is

A total of 80 participants were selected very large9. Convenience Sampling is said
based on inclusion criteria by ‘convenience to be more appropriate for the study in
sampling’ as it was not possible to approach which the aim is to get in-depth
10
all the student population in Sheffield information .
Hallam University. It is practically easy and
TABLE 1- INCLUSION AND EXCLUSION CRITERIA:
INCLUSION CRITERIA EXCLUSION CRITERIA

Students of Sheffield Hallam University. Students who were not using laptop/Desktop.
Students who were using Laptop/ Desktop for Students who were not student of Sheffield Hallam
their course work. University.
Students who knew English Language.
Data collection: among the colleagues to check for content

The data was collected through the survey validity and suggestions were considered
method by using a tool called a while reframing the questionnaire. The
questionnaire as it is the essential form of a questionnaire was pilot tested with 7
11
survey to a large sample population . A participants and the information was taken
questionnaire is an important method of into consideration while making final
11
survey to a large sample population . The questionnaire. Changes were made in 7
questionnaire consisted of both close and questions after piloting of the study. The
open ended questions. Close ended evidence suggested that, for the
questions were objective and unambiguous. questionnaire to be valid and reliable, it
Open ended questions were used for should go through the formal pilot of the
collection of larger amounts of information. questionnaire by the same sample
The questionnaires were developed on the population12.
basis of Environmental and Occupational
Health and Safety Service (EOHSS) Data Analysis:
Computer Workstation Ergonomics The main purpose of data analysis is to
Questionnaire. Prior to the implementation identify what the texts of participants talk
of questionnaire, they were circulated about. The qualitative content analysis is
used to process and analyse the information 5. Code all the text: Involves coding
given in text format or from an open ended all the data which have been.
13
questions . The data gathered was more Different units/keywords with
descriptive, hence it was suitable for similar sense were given single code
14
qualitative content analysis . 6. Assess coding consistency: This
Hence, the qualitative content data step involves rechecking the
15
analysis was used for data analysis, which consistency of coding.
involves the following steps: 7. Draw conclusion from the coded
1. Prepare the data: Present all the data: This step involves making
data collected in a chart format. sense of themes and identified their
2. Identifying the unit of analysis: properties.
Identify the different Rigour of analysis was enhanced by a
Units/keywords from the text. several-stage process of defining and
3. Developing categories and a refiningthemes, by constant comparative
coding scheme: It can be derived analysis between scripts and themes until
from three sources: the data, final themes were developed. This analysis
previous related studies, and theories. produced 7 key themes, which are listed
4. Code testing on a sample of text: It with their definition in Table 2.
is used for the clarity and
consistency of category definitions.
TABLE- 2: Main Themes from Data Analysis.
THEMES DEFINITION
Factors which facilitates the use of Reasons because of which students use
LC. LC.
Preference of use of Laptop/Desktop in What’s the reason for preference of

LC using Laptop/Desktop.
Symptoms faced while Which all symptoms the participants

using Laptop/Desktop suffer and what’s its cause?
Posture Awareness Awareness about the posture in

participants.
Environment/ Infrastructure of LC How is the environment and setting of

LC for the use of laptop.
Interference with extra How does the extra computer-accessories

Computer-accessories. interfere the level of comfort and increase
the work efficacy.
Recommendation to Improve LC What changes can be done to improve the

LC for the use of Laptop.
RESULT: “psychological motivation they get in

The questions which were related were put learning centre for study”.
into similar themes and then the results
were presented on the basis of sub-themes. Preference of use of laptop or desktop in
learning centre
Factors that facilitates use of Learning When the participants were asked whether
Centre they use laptop or desktop in learning centre,
Almost all participants were using the 42 participants said that they use desktop as
learning centre for their course work they feel it convenient and comfortable.
because of better facilities or resources like- They said that they "do not have to bring
"Books, Journals, area, IT laptop and it is easy for them to use desktop
equipment/resources, café etc.", while many than laptop". Some of them said that, they
participants said that they prefer Learning "prefer desktop because of big screen of
Centre because they like the environment of desktop and also there is less space and
Learning Centre as it is "Quite place and plug points for laptop in learning centre…".
easy to concentrate for the study". Some of Few of the participants said that it is "easy
the participants use Learning Centre to work on desktop as the desktop is fast
because of the convenience and comfort, and more comfortable" and also they "can
like- they can "use leisure hours between use it for prolonged period of time…". Only
the lecture, the convenient opening and 11 participants said that they use laptop in
closing hours of Learning Centre and group learning centre because they "prefer to use
study/work". Few of participants said about laptop" and also it is "convenient for them
to save their data". Some of the participants
said that they use laptop as they "can use it Posture Awareness
anywhere in learning centre, comfortable, Out of 80 participants, 55 participants stated
easy to use and it is more portable…". a positive response and defined posture in
their own words, while 25 participants have
Problems or symptoms faced by given negative response as they were not
participants while using laptop or desktop aware with the correct position or posture
From the result it was observed that, the for the use of laptop. The participants who
most experienced symptoms were “Tight, were not aware about the posture were
sore neck and shoulder muscles”, followed mainly from the faculty other than health
by “Pain or aching in wrists, forearms, related courses such as: Criminology,
elbows, neck, or back followed by Events management, Information system
discomfort”, and then “General fatigue or management, Law etc. Most of the
tiredness”, then “Blurred or double vision”. participants said, usually posture means: sit
Also it was found that, the least faced straight, back support, hip and knee flexed,
symptom was “Swelling or stiffness in the and screen at eye level. Some of the
hand or wrists”. statements given by the different
Most of the participants said that, these participants to define posture for laptop are
symptoms are because of their bad or poor presented below:
posture like- (Keeping laptop on knee, using
laptop while lying down, Slouched posture “Screen in line with eyes, elbow flexed to
etc.), continuous position such as: (Sitting 90°, knee at 90°, hip at 90°, shoulder flexed.”
for prolonged, focusing on small screen for (2)
long period, no interval between work etc.),
and ergonomics setup like- (Desks and “Back support, Hip + Knee supported,
chairs not adjusted, Too close to screen for Appropriate Height.” (39)
long period etc.). Some of the participants
said that there might be some other reasons “Sit erect, avoid neck flexion, sitting at
for the symptoms like- (weak joint, poor comfortable distance, and avoid excessive
posture throughout the day, Back and neck elbow bending.” (62)
pain from exercise).
Environment or Infrastructure of fewer resources such as: “Area, less table

Learning Centre (LC) and chairs, less space around the table”.
More than half of participants found
environment of learning centre to be Interference with extra computer-
comfortable for the use of Laptop. accessories like- keyboard and mouse on
Participants found environment of learning laptop work
centre comfortable because of different Out of 80 participants, some of the
resources like- “Tables, adjustable chairs, participants answered that, use of extra
more space for laptop, plug points, proper equipment like- mouse and keyboard could
lighting and easily accessible resources”. provide more comfort and can work with
While less than half of the participants greater ease. Participants answered that use
found the environment of Learning Centre of extra equipment can provide more
is not comfortable for laptop use. comfort, free movement and also they can
Participants said that, there is “less space, modify their position accordingly. Some of
less number of tables for laptop, tables and the participants said that “mouse is better
chairs are not setup at proper height or not than touchpad” and they can “work faster
adjustable, and also there is less charging and in more comfortable way”. Few
plug/points for laptop use”. participants answered that use of keyboard
When asked about the infrastructure/ setting and can provides “more comfort to them
of Learning centre, most of them said that and they do not have to negotiate with
the environment of learning centre is posture”. While more than half of
comfortable because of “tables and participants answered that, they do not find
adjustable chairs, proper lighting and quite any difference in comfort level with the use
area”. While one quarter of participants did of extra keyboard and mouse in the Laptop.
not find the infrastructure of LC to be Some of them said that they “do not want to
comfortable because of different difficulties carry keyboard and mouse and also they
such as: “Limited space around the table, can manage fine without it”.
uncomfortable chairs, cold environment,
chairs do not have armrest, very much Recommendation to improve Learning
crowded”. Some of them said that there are Centre for use of Laptop
Major number of participants have condition16. Student population use laptops

suggested with different recommendation in the learning centre because of the many
for the use of laptops in learning centre so benefits of the laptop. It is easy to carry and
that laptop can be used for extended period use laptop as the participants can save their
of time. Most of them want “proper data17.
ergonomic setup for laptop users, more It was observed that most of the participants
laptop area, more spacious table, experienced some of the symptoms while
comfortable chairs with neck and back using either laptop or desktop. From the
support, and plug points for laptop data gathered by questionnaire, it was found
changing”. Some of the participants have that the participants faced problems related
suggested for the “Laptop stand, specific to neck, shoulder, hand, back and eyes. The
type of table for laptop and dock station for most common symptoms were “Pain or
laptop”. Few of the participants said that aching in wrists, forearms, elbows, neck, or
there should be “more tables for laptop in back followed by discomfort” (42%) and
silent area and also individual/ separate eye strain (42%). Similar type of results was
booth/ room for laptop users”. found by Kumari and Pandey (2010) and
said that the common causes of these
DISCUSSION symptoms were sitting for prolonged in
This qualitative study obtained student’s awkward or poor posture (Fig-1). Also the
perception about laptop ergonomics and its literature suggested that the participants
use in the learning centre of SHU. Almost should take eye break every after 20 min to
all participants use learning centre for their reduce strain on eye while working on
course work because of the better laptop18. It was also found that participants
environment and different types of who use laptop faced more symptoms than
resources available. The environment of the one who use desktop. This could have
learning centre provides more comfort and been in order to adjust the posture to use
motivation to the students for the study, desktop and laptop in more comfortable
because the setup of the environment is position3. Even evidence proves that
study oriented. It has also been shown that participants adopt poor posture because of
hot and noisy environment directly affects the lack of adjustability of the laptop as the
the work productivity and ergonomic screen and keyboard are attached2. This was
supported by another study by Straker et al. communal table which are being used for
(1997a), they have suggested that usually laptop use are of very low height so it is
laptop users tried to assume posture that difficult to adjust the chairs accordingly. As
would compromise their posture by the evidence by Straker and Harris (2000)
increased neck, shoulder and elbow flexion. suggested that the participants experienced
They adopt this posture in order to see a physical discomfort because of the physical
lower screen and reach a higher keyboard. ergonomic issues as they use the laptop in
The main factors judged by the participants poor posture. This was supported by Moffet
as cause of their symptoms while using et al. (2002) in their study; evaluated the
laptop or desktop were “Sitting in same impact of two work station (desktop and
posture for continuous long hours”, laptop) on neck and upper posture, muscle
“Awkward and poor posture”, and the activity and productivity. The study said
“setup for laptop” which was not that the workstation setup influenced the
ergonomically correct. physical exposure variable while working
As the height of table in the learning centre on laptop.
is not appropriate, and also some of the
Fig-1: Shows the poor and good posture for Laptop.
Some of the participants who were not of lack of awareness about ergonomics
related with health course, they did not among that students population. So the
know about the correct position or posture participants adopt the poor posture while
for the use of laptops. They have not working on laptop, because it has been
defined the posture. This might be because found that lack of knowledge about posture
can leads to symptoms as they do not adopt Kumari and Pandey (2010) found that the
the proper posture while working on use of various computer accessories like-
5
desktop or laptop . adjustable keyboard tray, foot rest, best-fit
From the result it was also found that use of computer mouse design, task lighting and
extra computer- accessories can provide docking station can help in preventing the
more comfort, and can ease the symptoms health related symptoms. Even some of the
and increase the work efficacy of the participants have suggested for the use of
participants. This is because the extra laptop stand or docking station (Fig-2). It
equipment provides the adjustability might be helpful because they can fix the
according to the posture and the users do laptop and can use it in ergonomic way so
not have to compromise with the posture. that the symptoms can be prevented.
This was supported by a study done by
Fig-2: Show the ideal Laptop stand/Docking station for laptop.
According to the ergonomic advice by The study has suggested the use of docking
Stanford University, Environment Health station, so that the subjects do not have to
and Safety, the laptop workstation has been adopt the poor posture and can use laptop in
suggested, so that the laptop could be used effective way.
as workstation if working for long hours The study had several limitations. Many of
and the symptoms can be minimized. the participants have not answered all the
Moffet et al. (2002) have given some questions which might be because of lack of
advices to prevent pain while using laptop. interest, lack of time or the structure of the
questions. All the analysis and calculations spread though the means of Poster,
were done manually so there might be some distributing leaflets, and induction or
chances of manual error. It was not possible seminar. The findings about the
to explore in-depth perception of recommendation in improving learning
participants as the method of data collection centre can be given into the notice to the
was questionnaire. The sample size (n=80) learning centre authority Dept., so that they
in the study was relatively large, which was can use the finding as feedback in
the strength of the study. The participants improving the learning centre for better use
were from different faculties, which might for students and staffs. And also the
have result in variable data as the students students will be benefited by these changes
from different course have different and they might be able to use learning
perception about the ergonomics. Rich centre in more efficient way.
informative data were gathered through the The data of this study also has a further
open-ended questionnaire, which was one of clinical relevance; Symptoms are mainly
the aims of qualitative research. because of poor posture and wrong setup of
workstation of laptop, so in order to prevent
CLINICAL IMPLICATION: those symptoms, both the factors should be
Laptop ergonomics is very applicable for all corrected.
who use laptops. The result of this study
might help not only the student populations FURTHER RESEARCH:
but also the general population who use As this was the first study to researcher's
laptop. As it was found that there is lack of knowledge done on the student population
awareness about the proper posture for in SHU about laptop ergonomics, so an
laptop use among students, so the measure obvious need for more research in this area
should be done to spread the awareness. is observed. More research should be done
Mainly the student population, who are not in order to find out the actual ergonomic
from health related courses, should be setup of the working environment in the
focussed. It might be very helpful if there learning centre.Also a quantitative study
should be some induction about the posture could be suggested as further research in
for the student population before start of the order to find out the effectiveness of
course. Awareness about the posture can be ergonomics training program on posture
while working on laptop. Looking to the From the research done, it can be seen that
current scenario it seems that in coming 10 students population prefer to use learning
years laptop or i-pad or tablet will be centre because of the different facilities and
replacing the desktop so the study should be environment. But they also get symptoms
conducted in order to find out how the by using the resources like- desktop or
learning centre should be designed laptop, which is because of wrong posture
ergonomically for laptop or i-pad or tablet they adopt while working. So these
use. resources should be set-up on the basis of
CONCLUSION: ergonomics way and awareness about the
posture should be spread among students.
REFERENCES:
1. Gulek, J. C. and Demirtas, H. Learning 4. Moffet, H. et al. Influence of laptop
with technology: The impact of laptop use computer design and working position on
on student achievement. Journal of physical exposure variables. Clinical
Technology, Learning, and Assessment, biomechanics, 2002;17(5):368-375.
2005;3(2).
5. Kumari, G. and Pandey, K.M. Studies on
2. Harris, C. and Straker, L. Survey of health problems of software people: A case
Physical Ergonomics Issues Associated with study of Faculty of GCE and GIMT
School Children’s Use of Laptop Gurgaon, India. International Journal of
Computers.International Journal of Innovation, Management and
Industrial Ergonomics, 2000;26;337-346. Techonology,2010;1(1):388-397.
3. Thrasher, M. and Chesky, K. Medical 6. Blome, M., Johansson, C. R. and

Problems of Clarinetists. Results from the Odenrick, P. Visualization of ergonomic
UNTMusician Health Survey. Texas Music Guidelines –A comparison of two computer
Education Research. 1998. Last Accessed aided systems to support vehicle
19th Dec 2011 at design.International Journal of Industrial
http://www.tmea.org/080_College/Research Ergonomics,2005.
/thr1998.pdf.
7. Szeto, G. and Lee, R. An Ergonomic their applications in nutrition education.

Evaluation Comparing Desktop, Notebook, Journal of Nutrition Education and
and Sub-Notebook Computers. Arch. Phys. Behavior, 2002;34: 224-230.
Med. Rehabilitation, 2002;83: 527-532.
14. Ffiman, A., Ebbeskog, B. and Klag,
8. Kumar, R. Research Methodology, A B.Wound care in primary health
step-by-step guide for beginners. 1st edn., care:district nurses’needs for co-operation
SAGE,London, New Delhi, 2005. and well-functioning organization. J.
Interprof Care,2010; 24: 90–99.
9. Marshall, M.N. Sampling for qualitative
research. Family Practice,1996;13: 522-525. 15. Mayring, P. Qualitative content analysis.
Forum: Qualitative Social
10. Patton, M.Q. Qualitative evaluation and Research,2000;1(2).
research methods. SAGE Publications.
Newbury Park London New 16. Ashraf, Shikdar, Naseem, and Sawaqed.
Delhi,1990:169-186. Worker productivity, and occupational
health and safety issues in selected
11. Paul, H.P., Yeowa, Rabindarnath, and industries; Computers & Industrial
Sen. Quality, productivity, occupational Engineering, 2003;45( 4): 563-572.
health and safety and cost effectiveness of
ergonomic improvements in the test 17. Shears, L. and McDonald. Computers
workstations of an electronic factory. and Schools. Victoria. Australian Council
International Journal of Industrial for Educational Research.1995.
Ergonomics,2003; 32: 147–163.
18. Ergonomic Recommendations for
12. Williams, A. (2003). How to write and Laptop Computer Use. Stanford University
analyse a questionnaire. Journal of Ergonomic program.[Online]. Last assessed
orthodontics,2003;30:245-252. on 17th Dec, 2011 at
http://www.stanford.edu/dept/EHS/prod/gen
13. Kondracki, N. L. and Wellman, N. S. eral/ergo/documents/laptop_guide.pdf
Content analysis: Review of methods and
19. Environmental and Occupational Health 21. Price, J.M. and Doewell, W.R. Laptop
and Safety Service (EOHSS). Computer Configuration in office: Effects on posture
workstation Ergonomics Questionnaire. and Discomfort.Human factors and
Last Accessed 19th Dec, 2011 at Ergonomics Society,1998;42:629-633.
http://www.umdnj.edu/eohssweb/publicatio
ns/directory.htm#Office 22. Straker, Leon, Jones, Kerry J.,Miller, an
Jenni. A comparison of the postures
20. Gold, J. E., et al. Characterization of assumed when using laptop computers and
posture and comfort in laptop users in non- desktop computers. Applied
desk settings. Applied ergonomics, ergonomics,1997a;28(4): 263-268.
2012;43(2): 392-399.
ACKNOWLEDGMENT:
A special thanks to my family and friends for their continuous support. Also thanks to the
management of Sheffield Hallam University for giving me opportunity to complete my study.
CORRESPONDENCE:
* Sheffield Hallam University, United Kingdom. Email: [email protected] **Sheffield Hallam
University, United Kingdom
Effectiveness of Educational Sessions on Reducing Diabetes in Women with

PCOS— A Pilot Study
B. Sharmila, BPT, MSc (Yoga)*, B. Arun, MPT**
Abstract: PCOS (Poly cystic ovarian syndrome) is one of the common syndromes in
females, around 10 % of females in world having PCOS. PCOS have a strong link on
Diabetes. Study is a descriptive study to find out the effect of educational session on
diabetes for women who has PCOS. Around 20 females with PCOS were selected, an
Educational session was conducted for duration of 4 weeks, and Diabetic
Questionnaire was given to analyze the knowledge of diabetes. Following the 4 weeks
of educational sessions, all participants have gained a good knowledge on PCOS and
Diabetes. This study concludes that educational session is very important for the
management of Diabetes and especially for females who has PCOS.
Key words: Type II diabetes, PCOS, Educational Session, Diabetic Questionnaire.
INTRODUCTION
Diabetes is one of the most common health family members due to the constant need
problems in the world. India is the capital of for decision-making and actions to promote
diabetes. Many studies conducted in India good glycemic control, an outcome
showed that prevalence of type 2 diabetes acknowledged as the foremost goal in
was more and it is increasing in urban diabetes care and treatment3.
populations1, 2. Diabetes exerts a significant The burden of diabetes on women is unique,
impact on the lives of individuals and their because the disease can affect both mothers
and their unborn children. Diabetes can glucose intolerance in PCOS women has
cause difficulties during pregnancy such as been reported to occur at an earlier age than
a miscarriage or a baby born with birth in the normal population (approximately by
defects. Women with diabetes are also more the 3rd-4th decade of life). However, other
likely to have a heart attack and at a risk factors such as obesity, a positive
younger age than women who do not have family history of type 2 diabetes and
diabetes. Type 2 diabetes is strongly hyperandrogenism may contribute to
associated with Women who suffer from increasing the diabetes risk in PCOS4.
PCOS (Poly cystic ovarian syndrome). Dr.Geoffrey Redmond said that “There is
PCOS is a leading cause of menstrual no question about the association” one of
irregularity and female infertility. The the problems is that people haven’t put the
Statistical links between diabetes and PCOS pieces together” He added that there is a
are very strong about 5%--10% of strong association between PCOS and
reproductive age women have PCOS and 50% Insulin resistance. While focusing the
--70% of women with PCOS also infertility and menstrual changes, health
experience insulin resistance and 20%--40% care professionals should also look for the
obese women with PCOS may have insulin chance of diabetes, and screening of
resistance and diabetes. diabetes is much desirable.
Polycystic ovary syndrome (PCOS) is a Women with polycystic ovary syndrome
common endocrine disorder, affecting (PCOS) are insulin resistant, have insulin
women in reproductive age, characterized secretory defects, and are at high risk for
by chronic anovulation and glucose intolerance. PCOS women are at
hyperandrogenism. The etiology of PCOS is significantly increased risk for IGT and type
still unknown. However, several studies 2 diabetes mellitus at all weights and at a
have suggested that insulin resistance plays young age, The prevalence rates are similar
an important role in the pathogenesis of the in 2 different populations of PCOS women,
syndrome. The risk of glucose intolerance suggesting that PCOS may be a more
among PCOS subjects seems to be important risk factor than ethnicity or race
approximately 5 to 10 fold higher than for glucose intolerance in young women,
normal and appears not limited to a single and the American Diabetes Association
ethnic group. Moreover, the onset of diabetes diagnostic criteria failed to detect a
significant number of PCOS women with cholesterol) and triglyceride levels in the
5
diabetes by post challenge glucose values . blood stream, as well as decreasing HDL
Type 2 Diabetes has pancreas that cholesterol (high-density
density lipoprotein - the
produces little or no insulin. As the pancreas "good" cholesterol.)
struggles to keep up with the body's need While there is no cure for diabetes, a
for more insulin, excessive levels of glucose number of steps can be taken to prevent
and insulin build up in the blood stream, complications.
plications. Research showed that losing
often leading directly to Type 2 Diabetes. 5-7%
7% of body fat and increasing physical
Certain factors
actors that figure in the onset of activity by taking a brisk walk 4-5
4 times a
PCOS are also implicated in the week can reduce risk of developing Type 2
development of Type 2 Diabetes: excessive Diabetes by almost 60%.
abdominal fat, high LDL "bad" blood
cholesterol and low HDL "good" cholesterol,
high levels of triglycerides and hypertension DIABETES PCOS LINK
(high blood pressure).
Although PCOS is much perceived as PCOS
gynecological disorder because it impairs
EXCESSIVE ANROGEN SECRETION
fertility and can cause irregular periods or
no periods at all. Evidences suggest that
PCOS is more of a disorder of the endocrine HORMONAL IMBALANCE
system with gynecological consequences. INSULIN RESISTANCE
Diabetes Prevention Program study
2001, study shows that all of the factors STIMULATE THE PANCREAS TO
SECRETE MORE INSULIN
associated with Insulin Resistance,
Polycystic
ic Ovarian Syndrome and Pre-
Pre HYPER INSULINEMIA
Diabetes are interrelated. Obesity and lack

of exercise worsen Insulin Resistance,
CELL DYSFUNCTION
which then has a negative effect on blood
lipid production, increasing VLDL (very
DIABETES
low-density
density lipoprotein), LDL cholesterol
(low-density lipoprotein
ein - the "bad"
damage and blindness. Overweight women

INSULIN RESISTANCE do not, however, have a monopoly of
Polycystic Ovarian Syndrome and its
HIGH SUGAR IN BLOOD related disorders because females of normal
weight and even lean women are also prone
STIMULATE THE PANCREAS TO to these conditions.
SECRETE MORE INSULIN
Insulin Resistance occurs when the body
produces enough insulin but its cells lack
INCREASE PRODUCTION OF
ANDROGEN
enough receptor sites to allow the
absorption of insulin at a cellular level.
Type 2 Diabetes develops when the body
either doesn't produce enough insulin or it
PCOS
can't process the insulin that is produced.
Aim of the study:
Need for the study:
It's important to understand the distinction
Study Objectives:
between Insulin Resistance and Type 2
To educate the patient about disease (PCOS)
Diabetes. Type 2 Diabetes is one of the top
and teach on link between PCOS and
fatal disorders in the World. In 2000, it was
Diabetes
the sixth leading cause of death and has
To make the patient learn about the
been associated with long term
preventive methods
complications affecting almost every part of
To reduce the risk of getting diabetes
the body, including blindness, heart and
To make patient to understand the
blood vessel disease, stroke, kidney failure,
importance of Diet, Exercises etc.
amputations and nerve damage. Obese
women are particularly susceptible to PCOS
METHODOLOGY:
and Type 2 Diabetes. A vicious cycle
The study is a descriptive study design, 100
quickly forms because these conditions, in
women with PCOS were examined by the
turn, put women at dramatically increased
Gynecologist and 20 women were selected
risk of Cardiovascular Disease, as well as
for the study. The subjects were selected
the development of many other serious
based on age group of 25—33years,
health conditions, including stroke, kidney
Married females, Married within 2 years, questionnaire and their performance was
Obese or female in Borderline obesity. No assessed. At the end of the 4 week class the
history of conception, No other questionnaire was repeated and assessed the
gynecological problems like irregular knowledge on diabetes for women with
menstrual periods or small uterus. No other PCOS.
relevant medical problems. Before initiating
the study Blood test was conducted to check RESULTS:
their random blood sugar levels. Clear The demographic data about the subjects
instructions were given to all the were mentioned in Table 1.
participants. The educational class is for 4 Table 1
Demographic Data
weeks of duration and the Diabetic educator
role is to make all participants attending all 25—27 28—30 31—33
Age Group
the sessions. Prior to the class a Diabetic 7 6 7
knowledge Questionnaire was distributed to

Figure 1
all individuals and to find out how much
knowledge on Diabetes and PCOS. The
questionnaire was a single paged one which
includes the questions about the knowledge 7 7
on diabetes and the knowledge on PCOS.
The participants were asked to fill up the
questionnaire with Yes or No. Questions are 6
valued as 1 point for Yes and 0 point for No.
Educational Classes conducted on Every Age 25-27 28-30 31-33
Sunday Morning (10 am —1 pm). The

content of the Classes include 1) What is The Table 2 shows the result using students ‘t’ test.
PCOS 2) What are the Causes 3) Symptoms Pre Post Paired ‘t’
Test Test S.D Value
of Diabetes with PCOS 4) Diabetes Link Groups mean mean
with PCOS 5) Prevention Methods. The 14.19
3.8 7.85 0.285
(P<0.05%)
questions asked by the women participants
were clarified. At the end of the programme
all participants were instructed to fill up the
Figure 2 be prevented as well as prevent the

complications following diabetes.
157
200 Women with PCOS (Polycystic Ovarian
150 76 Syndrome) who become pregnant may
100 experience more health problems than the
50 general population, including gestational
0 diabetes, pregnancy-induced
pregnancy high blood
Pre Post pressure, miscarriage and premature
delivery.
Table 2 shows the paired t values of the Diabetic Polycystic ovary syndrome (PCOS) is a
Questionnaire. This shows that the educational common endocrine disorder, affecting
programme has shown positive effect on the
women in reproductive age,
ag characterized
participant’s attitude. It also shows that there was a
by chronic anovulation and
significant improvement on the knowledge on
diabetes mellitus. hyperandrogenism. The etiology of PCOS is
still unknown. However, several studies
DISCUSSION: have suggested that insulin resistance plays
Women with PCOS are generally an important role in the pathogenesis of the
Overweight or Obese. Because of obesity syndrome. The risk of glucose intolerance
intoleranc
they have more chance of insulin resistance. among PCOS subjects seems to be
Usually women with PCOS don’t have a approximately 5 to 10 fold higher than
regular check up on diabetes. But screening normal and appears not limited to a single
for diabetes is very important in prevention ethnic group. Moreover, the onset of
of diabetes. A root cause of Polycystic glucose intolerance in PCOS women has
Ovarian Syndrome (PCOS) is obesity- been reported to occur at an earlier age than
linked Insulin Resistance, which can also in the normal population
popul (approximately by
increase the risk of developing Pre-Diabetes
Pre the 3rd-4th
4th decade of life). However, other
and Type 2 Diabetes. All are disorders that risk factors such as obesity, a positive
may result in Cardiovascular Disease family history of type 2 diabetes and
leading to a heart attack or stroke. Creating hyperandrogenism may contribute to
self awareness in people with PCOS is very increasing the diabetes risk in PCOS
important, so that the Type 2, diabetes can
The link of PCOS with insulin resistance lack of uniformity between patients, thus
was subsequently established by clinical reflecting the heterogeneity of PCOS.
studies characterizing the profound insulin Impaired insulin action and/or beta-cell
resistance in obese and lean PCOS patients. dysfunction and/or decreased hepatic
Insulin resistance, hyperinsulinemia, and clearance of insulin have been implicated so
beta-cell dysfunction are very common in far.
PCOS, but are not required for the diagnosis. The overall risk of developing diabetes
Polycystic ovary syndrome (PCOS) is a mellitus and glucose intolerance seems to be
major risk factor for impaired glucose higher in women with polycystic ovary
tolerance (IGT) and type 2 diabetes mellitus syndrome (PCOS) than in healthy women.
(T2D). Several studies have examined Limitations of this study include, no control
possible mechanisms related to glucose group, it was a pilot study; need a bigger
metabolism and insulin secretion that may study to evaluate the effectiveness of the
be responsible for the high prevalence of programme. Blood report investigations can
disorders of glucose metabolism in women show some reliable information. Efficacy of
with PCOS. The actual pathogenic the treatment can also be evaluated through
mechanisms appear to be complex and objective methods.
multifactorial, possibly characterized by the
REFERENCE:
1. Mohan V, Shanthirani S, Deepa R, slum population in northern India.
et al. Intra urban differences in the Int J Obes 2001; 25: 1-8.
prevalence of the metabolic
syndrome in southern India - The 3. Brown S: Studies of educational
Chennai Urban Population Study interventions and outcomes in
(CUPS). Diabet Med 2001; 18; 280- diabetic adults: a meta-analysis
287 revisited. Patient Educ Counsel
16:189–215, 1990.
2. Misra A, Pandey RM, Rama Devi J,
et al. High prevalence of diabetes, 4. Pelusi B, Gambineri A, Pasquali R..
obesity and dyslipidaemia in urban Type 2 diabetes and the polycystic
ovary syndrome. Minerva Ginecol. 9. Canadian Diabetes Association.

2004 Feb;56(1):41-51. (1998). 1998 clinical practice
guidelines for the management of
5. R. S. Legro et al. “Prevalence and
diabetes in Canada. Canadian
predictors of risk for type 2 diabetes
Medical Association Journal, 159,
mellitus and impaired glucose
S1-S29.
tolerance in polycystic ovary
syndrome: a prospective, controlled
10. Chobanian AV, Bakris GL, Black
study in 254 affected women,” The
HR, Cushman WC, Green LA, Izzo
Journal of Clinical Endocrinology
JL, Jones DW, Materson BJ, Oparil
and Metabolism, vol. 84, no. 1, pp.
S, Wright JT, Roccella EJ: The
165–169, 1999.
seventh report of the Joint National
Committee on Prevention, Detection,
6. Alberti KG, Zimmet PZ: Definition,
Evaluation, and Treatment of High
diagnosis and classification of
Blood Pressure: the JNC 7 report.
diabetes mellitus and its
JAMA 289:2560–2572, 2003
complications. Part 1: diagnosis and
classification of diabetes mellitus 11. Codner E etal., 2006, Diagnostic
provisional report of a WHO criteria for Polycystic ovarian
consultation. Diabet Med 15:539– syndrome and ovarian morpholly in
553, 1998 women with Type II diabetes,
Endocrine Med : Jun 91 (6): 2250-6.
7. American diabetic association
(1999), American association guide
12. Isomaa B, Almgren P, Tuomi T,
to medical notional therapy and
Forsen B, Lahti K, Nissen M,
diabetes.
Taskinen MR, Groop L:
Cardiovascular morbidity and
8. Balkau B, Charles MA: Comment
mortality associated with the
on the provisional report from the
metabolic syndrome. Diabetes Care
WHO consultation. Diabet Med
24:683–689, 2001
16:442–443, 1999
13. Kitzinger C, Willmott J: ‘The thief 17. Reaven GM: Banting lecture: Role
of womanhood’: women’s of insulin resistance in human
experience of polycystic ovarian disease. Diabetes 37:1595– 1607,
syndrome. Soc Sci Med 54:349–361, 1988
2002
18. Sarah Wild, Mb Bchir, Phd, Gojka
14. Lakka HM, Laaksonen DE, Lakka Roglic, Md, Anders Green, Md, Phd,
TA, Niskanen LK, Kumpusalo E, Dr Med Sci, Richard Sicree, Mbbs,
Tuomilehto J, Salonen JT: The Mph, Hilary King, Md, Dsc, Global
metabolic syndrome and total and Prevalence Of Diabetes, Diabetes
cardiovascular disease mortality in Care 27:1047–1053, 2004
middle-aged men. JAMA 288:2709–
2716, 2002 19. Taylor AE, 2000, Insulin Lowering
medications in Poly cystic ovarian
15. Legros RS et al., PCOS prospective syndrome. Obstet gyneol Clin north:
controlled study in 254 affected Apr 27: 583—595.
women, J clin endocrine metan:
84:165—169. 20. The Expert Committee on the
Diagnosis and Classification of
16. Pouliot MC, Despres JP, Lemieux S, Diabetes Mellitus: Report of the
Moorjani S, Bouchard C, Tremblay Expert Committee on the Diagnosis
A, Nadeau A, Lupien PJ: Waist and Classification of Diabetes
circumference and abdominal Mellitus. Diabetes Care 20:1183–
sagittal diameter: best simple 1197, 1997
anthropometric indexes of
abdominal visceral adipose tissue 21. WHO Study Group Report.
accumulation and related Prevention of Diabetes Mellitus.
cardiovascular risk in men and Geneva: World Health Organization;
women. Am J Cardiol 73:460–468, 1994. WHO Technical Report series
1994 no. 844.
APPENDIX I
DIABETIC QUESTIONNAIRE
Name : Date :
Age :
Occupation :
Address :
Weight :__________ Kgs.
Height : __________CMS
BMI :
Do you have Diabetes : YES / NO

If YES, How long :___________ Months/ Years.
Are you in medications for Diabetes : YES / NO
If YES, Specify medicines : ________, ___________, ___________
Do you have PCOS : YES / NO

If YES, Since when : ____________ Months / Years
Are you in medications for PCOS : YES / NO
If YES, Specify medicines : ________, ___________, ___________
Please fill up the given statement with Yes or No.
S.No STATEMENT Yes No
1. Do you know symptoms of Diabetes
2. Do you know about PCOS
3. Do you know Obesity may cause Diabetes
4. Do you know Obesity may cause PCOS
5. Do you know relation between PCOS & Diabetes
6. Do you know the Risk factors for Diabetes
7. Do you think it is good to do Exercises regularly
8. Do you think intake of Rice may cause Diabetes
9. Do you think you can get Diabetes
10. Do your Parents or Relative have Diabetes
Signature of the Participants Signature of the Assessor
CORRESPONDENCE:
*Physiotherapist, K.M.C.H Hospital, Coimbatore. Email: [email protected]. **Physiotherapist, K.G.
Hospital, Coimbatore.
Efficacy of McKenzie Approach combined with Sustained Traction in

improving the Quality of life following low Back Ache – A Case Report
A.Sridhar MPT (Neuro)*, S.Vimala BPT**
Abstract: Objective: To evaluate the effectiveness of traction combined with

McKenzie approach for the sub acute low back ache (LBA) patient and evaluating the
quality of life post treatment. Design: Single Case Report Setting: PSG Hospitals
Participant: A 45 years old female with the complaint of LBA with 6 month duration,
gait problem, participatory problem in social activities and also with the impairment
of function. Intervention: One hour session of physiotherapy including traction and
McKenzie exercises interrupted with rest period. Outcome Measures: Visual
Analogue Scale (VAS) (Pain), Quality of life (QOL) (American chronic Pain
Association). Result: There is a significant reduction of pain and improvement of
quality of life after one month of treatment. Conclusion: McKenzie exercises
combined with traction plays a major role in reducing pain and improving the quality
of life following Low Back Ache patient.
Key words: LBA, McKenzie, Traction, Quality of Life, Visual Analogue Scale.
INTRODUCTION
LBP affects 70–80% of adults at some point pain is a common disorder. Nearly everyone
in their lives, with peak prevalence in the is affected by it at some time. The acute low
fifth decade. The drastic increase in LBP in back pain may develop to chronic pain and
the past two to three decades. Low back disability. The treatment of low back pain
remains as controversial today as it was Basically she is from rural area and there is
fifty Years ago. Over the years the medical no facility for her to go for hospitals. But
profession used a wide range of treatments, she went to nearby physician and she got
such as heat or cold, rest or exercise, flexion some pain medications and tropical
or extension, Mobilization or ointments for pain relief. As time goes on
immobilization, manipulation or traction. she is complaining of severe pain in the
Nearly always drugs were prescribed, even back and unable to walk for even 10
when the disturbance proved purely minutes continuously. She feels weakness
mechanical in origin. Amazingly, most of of bilateral lower limb and restricted her
the patients recovered, very often inspite of participation in the social activities and also
treatment rather than because of it. But reducing the usual work what she is doing
McKenzie approach in LBA is on regularly. She could not do even carrying
mechanical basis and he assessed the the drinking water from a distance place as
movements of spine and also the treatment their primary need.
is based on the patient complaints of pain
whether in flexion or extension or lateral Misdiagnosis:
flexion. So we had tried to apply this After she felt more discomfort she went to
technique coupled with traction for LBA various hospitals and diagnosed as GBS,
patient. and someone diagnosed as disc herniation
and advised her to go for surgery. She was
METHODOLOGY: confused and she refused to undergo

surgery. Finally she came to our hospital
Case History: and she got medications. In the mean time
A 46 years old female came with the we send her for the neuro consult but the
complaints of pain in the bilateral lower neurologist also advised her to take MRI
limb, difficulty in walking, getting up from and after the he also advised her to go for
the floor, and toileting activities for 6 month surgery.
duration. But she doesn’t complaints of any Being a low economic status she could not
sensory loss over the bilateral lower limb spend more money and she refused for
and also in anal area. surgery and come back to our hospital with
the reports.
Its is widely used to measure the severity of

Our Views: pain from patient feeling of pain. Zero
As we (Physician, Junior Doctors and indicates no pain and 10 indicate severe not
Physical therapist Team) read the MRI and tolerable pain.
also observed her complaints of pain. We
taught that she does not need surgery at this Quality of Life:
stage and we make her bed rest for one day American Chronic Pain Association created
and we started our own assessment and this measure with the following explanation.
treatment procedures. Pain is a highly personal experience. The
We underwent observational, palpation, and degree to which pain interferes with the
examination of various movements quality of a person’s life is also highly
including reflex, muscle strength, balance, personal. The American Chronic Pain
coordination and Activities of daily living. Association Quality of Life Scale looks at
We came to the conclusion that she had a ability to function, rather than at pain alone.
derangement syndrome one with complaints It can help people with pain and their health
of symmetrical pain across L4, L5, no care team to evaluate and communicate the
radiating pain and no deformity so it comes impact of pain on the basic activities of
under the first type of derangement so we daily life. This information can provide a
decided to treat her with McKenzie basis for more effective treatment and help
approach and traction. As McKenzie to measure progress over time.
exercises are very much appreciated in Scoring system zero indicates non
treatment of lower back ache population in functioning and ten indicates normal quality
world wide. we tried our traditional of life.
approach of traction and McKenzie
approach Treatment protocol:
Outcome Measures: Traction:

1. Visual Analogue Scale (VAS). Sustained Traction
2. Quality of Life (QOL). This term denotes that a steady amount of
traction is applied for periods from a few
Visual Analogue Scale: minutes up to ½ hour. This shorter duration
is usually coupled with stronger poundage. Table 1.1 Comparing

omparing the visual analogue
This method
thod is most widely used in Europe scale on the first visit and 4th week
and much of the literature describes various

Visual Analogue Scale (Pain)
applications of sustained traction. Sustained
traction is sometimes referred to as static
1st visit 2nd Week 3rd Week 4th Week
traction. As per the patient’s weight we
applied 15kg of lumbar static traction for 30
9 7 4 0.5
minutes.
McKenzie Exercises: Graph 1.1 comparing the values of visual
This is a set of exercises we asked her to do analogue scale
for 30 min. 10
1. Prone Lying. 8
6
2. Extension in prone lying (forearm
4
support). 2
3. Extension in prone lying ( hand support). 0
1st visit 2nd Week 3rd Week 4th Week
4. Extension in prone lying with belt
fixation. Visual Analogue Scale (Pain)
5. Sustained extension in tilt bed.

Initially when we assess in VAS she
6. Extension in standing.
complaints of pain as nine and at the end of 4th
7. Extension Mobilization (Therapist doing
passively) week she complaints of 0.5 which means near
normal.(table
(table 1.1)(graph 1.1)
RESULT AND INTERPRETATION:

The assessment is taken on the first visit, Table 1.2 Comparing the quality of life
2nd week, 3rd week, and 4th week. scale on the first visit and 4th week
According to McKenzie approach at any
time of disease the particular
particul form of
Quality of Life ( American chronic Pain
exercise may worse the condition so we are
Association)
assessed her at one week interval.
1st 2nd Week 3rd Week 4th Week
visit
DISCUSSION:
1 4 8 10
There are various treatment procedures
p are
widely used in treating the LBA cases. On
Graph 1.2 comparing the values of Quality Of reviewing 21 papers in 1995, only one paper
Life Scale
cale was found to be of
high quality, Van der Heijden concluded no
10
9 inferences could be drawn(Phys Ther 1995).
8
A trial by Cherkin (N Eng J Med 1998)
7
6 compared threee groups: chiropractic
5
manipulation, McKenzie exercise, vs
4
3 education leaflet. He did not find any
2
1
difference among the three groups with
0 regard to pain recurrence or days off work.
1st Visit 2nd Week 3rd Week 4th Week
The chiropractic group performed
Quality of Life ( American chronic Pain significantly better than the minimal
Association)
intervention
rvention group at 4 weeks, but not at 3
months and the 11-year. But as per the
Initially when we assess in QOL she
complaints of the patient we have to choose
complaints of 1, and at the end of 4th week
the technique and apply with precautions
she complaint of 9 which means she can
and assess the patients periodically to get
work for 8 hours and she actively
the knowledge of patients pain and related
participate in family and social
features.
es. This case report is a eye opening
activities.(table 1.2) (graph 1.2)
for the new physio to apply these
From the above mentioned table and graph
procedures widely for most of the LBA
its clearly seen that patient’s pain is reduced
patients and thereby improving the patient
and her quality of life is improved a lot.
condition. Static lumbar Traction is useful
Thereby this case report is strongly
for this patient as there is narrowing of the
recommending that traction coupled with
disc space, after
fter applying traction there will
McKenzie exercises are very much helpful
be a reduction of the nerve impingement.
in treating the disc herniation condition.
McKenzie had classified the low back pain
in 3 categories viz. dysfunction, postural This case report supports that traction
and derangement syndrome. As this patient combined with McKenzie exercises plays a
had complaint of derangement symptoms so major role in reducing pain and improving
we applied the treatment protocol for the quality of life.
derangement syndrome one.
Conclusion:
ACKNOWLEDGEMENT
Thanks to my client & PSG Hospitals and in treating the patients who need physical
also to our superintendent and deputy therapy.
superintendent for having confident with us
REFERENCES:
1. Lumbar spine, mechanical diagnosis and 3. Low Back Pain, royal college of
therapy,(1981) R.A. McKenzie, pages practitioners pages 3-39.
122-150 4. Lumbar traction, journal of orthopaedic
2. Orthopaedic rehabilitation, assessment and sports therapy 1979, H.duane
and enablement , John C.Y.Leong et al. saunders pages 36-40
pages 481-488.
CORRESPONDENCE
*Neurophysiotherapist- TLM Naini, UP. [email protected] Cont: +91-8765152734. **Physiotherapist
Trainer- TLM Naini, UP.
Diagnosis of Human Brucellosis by Laboratory Standardized IgM and IgG

ELISA
Rajeswari Shome*, M Nagalingam*, K. Narayana Rao*, B.Jayapal Gowdu**, B. R. Shome*

and K. Prabhudas*
Abstract:
Brucellosis is a zoonosis caused by facultative intracellular bacteria of the genus
Brucella, which are capable of surviving and multiplying inside the cells of
mononuclear phagocytic system. ELISA is rapid, robust, coast effective and is most
commonly used diagnostic technique for brucellosis. Our present research
communication deals with optimization of IgM and IgG antibodies for diagnosis of
brucellosis in human beings. In the present investigation, out of the 179 sera samples
from risk groups screened for brucellosis, 10(5.58%) and 4(2.23%) were positive for
anti Brucella antibodies by RBPT and STAT respectively. Seropositivity by IgM and
IgG ELISAs were 2.23% (4/179) and 17.3% (31/179) respectively. In case of blood
donors, out of 123 serum samples 1.62% and 4.87% were positive by RBPT and IgG
ELISA respectively. No antibodies were detected by STAT and IgM ELISA in blood
donors. Among serum samples from Pyrexia of Unknown Origin patients tested, 7. 61%
(15/197) by RBPT, 1.01% (2/179) by STAT and 0.5% (1/197) by IgM ELISA and
11.67% (23/197) IgG ELISA respectively were found positive.
INTRODUCTION
Brucellosis is a zoonosis caused by surviving and multiplying inside the cells of

facultative intracellular bacteria of the mononuclear phagocytic system and are
genus Brucella, which are capable of widely distributed in both humans and
animals1. Human brucellosis varies from an linked immunosorbent assay (ELISA) and
acute fabrile illness to chronic, low grade ill indirect fluorescent assays, to the recent
defined disease. It is a systemic disease molecular techniques such as polymerase
characherized by pausity of signs chain reaction (PCR) are available.5, 6, 7.
accompanied with nocturnal sweating, Isolation from blood, bone marrow and
2
malaise, fatigue and backache . The disease other tissues of suspect is classical
can be a very debilitating, despite the fact diagnostic (gold standard) method for
that the fatality rate is generally low. It brucellosis. However, this microbiological
often becomes sub-clinical or chronic, technique is having the draw back of time
especially if not diagnosed early and consumption as the organism is having
properly treated. The incidence in humans incubation period of 6 weeks and possibility
ranges widely between different regions, of contamination to personnel cannot be
with values of up to 200 cases per 100,000 avoided8. Rose Bengal Plate test (RBPT) is
populations with high prevalence in Middle commonly used for the screening of
East, Mexico, Central and South America brucellosis however results may at times
and the Indian subcontinents2, 3. High-risk inconclusive9. In standard tube
groups include those exposed through agglutination test (STAT), interpretation of
occupation in contexts where animal the result is difficult due to false positive
infection occurs, such as slaughterhouse reaction with Salmonella, Yersinia and
workers, hunters, farmers and veterinarians. Vibrio species. Further PCR is the
The diagnosis of brucellosis can be molecular technique which is employed for
challenging, and its diagnosis demands the detection of brucellosis, but the
epidemimology, clinical and laboratory technique is uneconomic and poorly suited
information. Its routine biochemical and for the laboratory with limited resources. In
hematological laboratory tests also overlap view of these limitations, robust , coast
with those of many other pathogens such as effective and rapid ELISA has been found
4
Salmonella, Yersinia, and Vibrio . Many an ideal tool for the diagnosis .
tests are reported for diagnosis of Brucella, In brucellosis, titre of IgM usually raises
ranging from microbilogical culture to from day 5 to 7 with peak titre and IgG
serodiagnostic tests such as slide or tube starts to appear from day 14 to 21, reaching
agglutination, indirect coombs test, enzyme- peak during next 2 to 3 weeks in the
infected individuals. Clinical applications according to standard procedures12. Briefly,

of IgM and IgG ELISA in human disease for the RBPT , undiluted serum sample (30
µl) was mixed with an equal volume of
10, 11
have been reported . This manuscript
deals with the study on diagnosis of colored antigen on a glass slide. The results
Brucella infection by laboratory were rated negative when agglutination was
standardized IgM and IgG ELISA protocol absent and 1+ to 4+ ratings as positive,
and its comparison to conventional according to the strength of the
serological tests. agglutination within 1 to 3 min.
RBPT positive samples were further
Materials and methods: evaluated by STAT and 2ME STAT by
Collection of sera samples preparing two-fold serial dilutions of the
During the course of the study, 2 ml of serum samples starting at a dilution of 1:20
blood samples without anticoagulant was in the test tube and the addition of an equal
collected aseptically in vaccutainers. The volume of plain antigen according to
samples were sourced from risk group Weybridge technique12. The 2ME test is
(veterinarians, para veterinarians, farm identical to STAT except that 2ME was
workers, animal-handlers and farmers), added to each test tube to a final
blood donors and patients with pyrexia of concentration of 0.05 M, and 0.85% saline
unknown origin (PUO). The pyrexia may be was used to dilute the antigen. The
due to systemic cause of rheumatic fever, mixtures were incubated for 24 hours at
jaundice, C reactive protein, hepatitis etc., 37°C and read by visual inspection for
The samples were allowed to clot, transparency of suspension and mat
transported to laboratory immediately at formation. The highest dilution of the serum
4°C. The serum was separated by which showed 50 percent agglutination was
centrifuging the sample at 2500 r.p.m for 5 taken as end point titre and titre of 1:160
min and stored at –20°C for further use. (320 IU/ml) and above was considered as
positive for humans brucellosis13, 14. The B.
Rose Bengal Plate Test (RBPT) and abortus S99 colored and plain antigens were
Standard Tube Agglutination Test (STAT) procured from Institute of Animal Health
Sera samples received were initially and Veterinary Biologicals (IAH&VB),
subjected to rapid screening RBPT Hebbal, Bangalore, India.
Preparation sLPS antigen extraction

Smooth Lipopolysaccharide (sLPS) Wet cells of Brucella (5 gm) were
antigen extraction suspended in 17 ml of distilled water and
Standard strain followed by the addition of 19 ml of 90%
Standard antigenic strain of B. abortus S99 (v/v) phenol at 66°C. The mixture was
procured from Indian Veterinary Research stirred continuously at 66°C for 15 min,
Institute, Izatnagar, U.P., India and cooled and centrifuged at 10,000 rpm for
confirmed as B. abortus by biochemical 15 min at 4°C. The brownish phenol in the
tests, PCR, cloning and sequencing in our bottom layer was aspirated with a long
was used for antigen extraction15. micro tip and large cell debris was removed
Large scale bacterial culturing by filtration (using a Whatman No.1
Freshly grown pure colonies were filter).The sLPS was precipitated by the
suspended in 10 ml of sterile PBS, after addition of 50 ml chilled methanol
vortexing, the bacterial suspension was containing 0.5 ml methanol saturated with
overlaid on Ttyptose Agar (TA) in Roux sodium acetate. After 2 hours incubation at
flasks. Thirty flasks were simultaneously 4°C, the precipitate was removed by
inoculated from the same master plate to centrifugation at 10,000 r.p.m for 10 min,
provide the identical bacterial population stirred with 8 ml of distilled water for 18
originating from a single colony. After one- hours and centrifuged at 10,000 r.p.m for 10
hour adsorption, Roux flasks were inverted min. The collected supernatant solution was
and incubated for 72 hours at 37oC. The kept at 4°C and this step was repeated
purity of the culture in every flask was twice for the best recovery of antigen. Then,
confirmed by Gram’s staining after 48 0.8 g of trifluroacetic acid was added to the
hours. To each flask, 30 ml of 2% phenol 16 ml of crude sLPS, stirred for 10 min and
saline was added, gently agitated and the precipitate was removed by
incubated for 24 hours at 37oC. The centrifugation. The translucent supernatant
suspensions were collected, pooled, solution was concentrated and dialyzed
centrifuged at 14,000 r.p.m at 4oC for 20 against distilled water (two changes of at
min. The centrifugation was repeated and least 4000 ml each) and then freeze dried to
pellets were carefully collected, weighed get the final yield of 10 ml of sLPS
and used for antigen extraction.
containing the antigen concentration of 3 The polysorp micro titer plates (Nunc,
mg/10ml. [16]. Germany) were coated with 1:300 dilution
The optimum concentration of antigen for of sLPS antigen at 100 µl per well in
ELISA was standardized by checkerboard carbonate-bicarbonate buffer (pH 9.6) and
titration against 1:100 and 1:200 dilution of incubated 4°C for overnight. Antigen coated
strong positive convalescent sera. The OD plates were washed three times with PBST
values were plotted on a graph and the point wash buffer (Phosphate buffered saline
where there was sharp fall on the line graph containing 0.05 % Tween 20) pH 7.2. Test
was taken as the optimum dilution of and control sera diluted in PBST blocking
antigen. buffer (1:100) containing 2% bovine gelatin
was added to respective wells (100 µl) of
Controls for ELISA the plates in duplicates (test sera) and
The convalescent sera for IgM and IgG quadruplicate (controls) and incubated at
ELISA were selected first by RBPT 37°C for 1hour. The plates were then
screening, the strong RBPT positive sera washed as mentioned earlier. The anti-
showing the 2 ME- STAT titer of 1:640 human IgG and IgM HRP conjugates
(1280IU /ml) and STAT titre of 1:1280 (Pierce, Germany), diluted 1:8000 and
was considered positive control for IgM 1:4000 respectively in PBST buffer were
ELISA and STAT titres of 1:1280 (2560IU added to all the wells (100 µl) and incubated
/ml) was considered as positive for 1 hour at 37°C on orbital shaker (300
convalescent sera control for IgG ELISA. r.p.m./min). After washing, freshly prepared
These sera samples were further confirmed o-Phenylenediaminedihydrochloride (OPD)
by DOT-ELISA antibody detection Kit (Sigma, Germany) solution containing 5 mg
(DRDE Jhansi, Gwalior, India). The OPD tablet in 12.5 ml of distilled water and
undiluted sera were used as strong positive 50 µl of 3% H2O2 was added and kept for
controls and sera from healthy donors as the color development for 10 min. Enzyme-
negative control. The moderate positive substrate reaction was stopped by adding
control was prepared by diluting strong 1M H2SO4 (50 µl) and color development
positive sera with 1:500 dilutions donor sera. was read at 492 nm using an ELISA micro
plate reader (Biorad). The optical density
Standard ELISA protocol (OD) obtained for the negative and positive
samples were interpreted by cutoff values tested, 2 (1.62%) and 6 (4.87%) were
set at 3 standard deviations above the positive by RBPT and IgG ELISA
arithmetical mean of the OD obtained for respectively. In case of PUO sera samples, a
17
the healthy controls . total 197 samples were analyzed, out of
which, 34(17.25%), 2(1.01%), 1(0.5%) and
RESULTS 23 (11.26%) were found positive by the
To obtain 5 gm wet weight of bacteria, RBPT, STAT, IgM ELISA and IgG ELISA
fifteen Roux flasks were used and from 5 g respectively (Table 1). Out of 27 RBPT
wet weight of bacterial cells, 10 ml of sLPS positive samples, only one sera (0.5%) was
was extracted (3mg). The convalescent sera found positive by 2ME-STAT.
positive by RBPT, DOT-ELISA and
showing 2ME-STAT titer of 1:640 (1280IU DISCUSSION
/ml) and STAT titres of 1:1280 (2560IU /ml) The true incidence of human brucellosis
were considered as positive convalescent however, is unknown for most countries and
sera controls for IgM ELISA and IgG no data are available for many parts of India.
ELISA respectively. It has been estimated that the true incidence
In ELISA, the 1 in 200 antigen may be 25 times higher than the reported
concentration was found optimum at serum incidence due to misdiagnosis and under-
concentration of 1 in 100 (Fig 1). Similarly, reporting. Several publications indicate that
the conjugate dilutions were established by human brucellosis can be a common disease
checkerboard titration and IgM conjugate in India. The ELISA was first developed by
of 1 in 4000 and IgG conjugate at 1 in 8000 Carlson et al, for the diagnosis of human
were found optimum dilutions for the test brucellosis and since then, a large number
(Fig. 2) of variations have been described18. ELISA
Among the 179 sera samples from risk have a distinct advantage over conventional
groups screened for brucellosis, 10(5.58%) serological tests in that, they are primary
and 4 (2.23%) were positive for Brucella binding assays that do not rely on secondary
antibodies by RBPT and STAT respectively. properties of antibodies such as their ability
In IgM and IgG ELISA, 4 (2.23%) and 31 to agglutinate or to fix complement.
(17.3%) were detected positive respectively. Secondly, ELISA can be tailored to be more
In case of blood donors, out of 123 samples
specific by using highly purified reagents at concentration of 1 in 200, serum

such as antigens and monoclonal antibodies. concentration of 1 in 100 and conjugate
The sLPS antigen of Brucella is considered concentrations of 1 in 4000 and 1 in 8000
the most important antigen during immune for IgM and IgG were optimum
response and is the target for many concentrations/ dilutions for the test.
serological and immunological studies. The Currently, RBPT is regarded as one of the
strains that are pathogenic for humans carry essential procedures for initial screening of
sLPS involved in the virulence of these livestock and humans for brucellosis. This
bacteria. It gives better sensitivity and test is sensitive, rapid and simple as well as
specificity with good reproducibility. It also it gives high throughput to localize the
possesses a convenient cut off value for range and frequency of the disease, but
diagnostic purposes. Finally, it is not suffers from low specificity13, 23. Similarly,
restricted to bovines alone and can be STAT is most preferred for serodiagnosis of
adapted to different species of animals as brucellosis in many countries, however,
well as to humans beings3. OIE recommended for its discontinuation,
The sLPS antigen coated passively on to a as the test is susceptible to false positive
polystyrene matrix is the method commonly reaction by cross reacting antibodies (IgM).
employed in the ELISA19. The indirect In our investigation, out of the 179 sera
ELISA and AB-ELISA have seen samples from risk groups screened for
standardized by several researchers using brucellosis, 10(5.58%) and 4(2.23%) were
sLPS antigen from B. abortus S99 to screen positive for anti Brucella antibodies by
the livestock and humans for brucellosis15, 19, RBPT and STAT respectively. Latest
20, 21
. According to Guarino et al.22, the high investigation reports from Karnataka
percentage of positivity was due to the revealed the similar findings of higher
ability of ELISA to detect very low levels prevalence in the risk group ranging from
of antibodies present in the early stage of 2.26% to 15.69% positivity among 618
infection, while RBPT and STAT cannot human samples by RBPT and indirect
detect it. Keeping this in view, a pilot study ELISA respectively21. A extensive study by
was aimed to develop and evaluate ELISA Mantur et al, reported the prevalence of 1.6%
for diagnosis of human brucellosis. In this and 1.8% by STAT (≥ 1:160) in 93 children
investigation, it was observed that, antigen and 495 adult patients respectively in
Bijapur24, 25. Further the incidence rate from infection in the donors might be due to the
other parts of the country has been reported exposure of the donors unintentionally to
26, 27, 28,
to be ranging between 0.9 and 18.1% the animals or due to the consumption of
29
. The higher prevalence rates reported by raw milk, or may be due to the cross
various researchers are in accordance with reacting antibodies such as vibrio or
our present findings in the high risk groups yersinia.
21, 25, 30
. High sero prevalence in the risk Brucellosis has fluctuating manifestations
group is attributed to constant exposure to with similarities to other un-diagnosable
infection due to contamination of hands and fevers, these patients were considered under
arm while handling animals and also human the category of PUO. These patients
infection can occur through aerosol, generally referred for various other
occupational exposure of abattoir workers, laboratory investigations, but not for
veterinarians and laboratory technicians. In Brucella testing. The presence of Brucella
addition, consumption of infected raw milk, antibodies in 197 PUO patients tested
raw milk products and raw meat can result ranged from 15 (7. 61%) and 2 (1.01%) by
in infection25. RBPT and STAT respectively and 0.5%
The transmission of brucellosis to man is and 11.67% by IgM and IgG ELISA
primarily by direct contact with infected respectively. A Similar studies on
animals or their products. However, the seroprevalence of 3.30% out of 121 PUO
organisms can also be transmitted by cases27, 6.8% of 414 patients with PUO33
transfusion of infected blood31. The blood and 0.8% seropositive cases in a group of
donors tested in the study, showed 1.62% 3,532 patients with PUO34 have been
positivity by RBPT and 4.87%, by IgG reported. In the present study, the higher
ELISA. Two such similar reports from sero prevecelance of anti Brucella antibody
Karnataka, revealed the prevalence ranging was detected ranging from 7.61% (RBPT)
from 1.8% (out of 26,948 adult donors ) to 11.67% (IgG ELISA). This is attributed
25
to 14.7% (out of 353 donors) by to the collection of samples from diagnostic
32
RBPT . These findings are relatively laboratories located in Bangalore rural areas
identical to our findings. The higher where intensive dairy is practiced. So
prevalence of 4.87%, in case of IgG ELISA exposure might be due to animal handling
signifies the better efficiency of test. This
(farmers) or consumption of unpasteurized of the disease in humans and to identify

milk active infection (IgM ELISA). The use of
In general, overall prevalence of the disease sLPS as antigen in the I-ELISA might be
by RBPT and STAT tests were 5.14% and one of the reasons for higher sensitivity as
1.2% respectively whereas, 1.00% and the stronger immune responses are elicited
12.02% by IgM and IgG ELISA against sLPS in infected individual. The
respectively. All the 27 RBPT positive sera advantage of using the indigenously
samples were found positive by either of the developed kit/tests is that the large number
two ELISAs confirming the 100% of samples can be analyzed economically
agreement of the test with the classical test and it will also help to generate
(RBPT. This numerical data is the evidence seroepidemiological data of the disease in
for the higher efficiency of the ELISA over the country. Screening of large number of
RBPT and STAT. The basic knowledge of sera samples and validation as per OIE
this study will help us for the development guidelines is underway.
of indigenous ELISA kit for sero screening
REFERENCES:
1. Jarvis BW, Harris TH, Qureshi N, blood donors. Indian J Med Micro
Splitter GA: Rough 2007; 25:302-304.
lipopolysaccharide from Brucella 3. Salmani AS, Siadat S, Fallahian MR,
abortus and Escherichia coli Ahmadi H, Norouzian D, Yaghmai
differentially activates the same P, Aghasadeghi MR, Mobarakeh JI,
mitogen-activated protein kinase Sadat SM, Zangeneh M,
signaling pathways for tumor Kheirandish M. Serological
necrosis factor alpha in RAW 264.7 evaluation of Brucella abortus S99
macrophage-like cells. Infect Immun Lipopolysaccharide extracted by an
2002; 70:7165-7168. optimized method. Am J Infe Dis
2. Vaishnavi C, Kumar S. Investigation 2009; 5:11-16.
for background prevalence of 4. Fadeel MA, Wasfy MO, Pimental G,
Brucella agglutinins among the Klenna JD, Mahoney FJ, Hajjeh RA.
Rapid enzyme linked
immunosorbent assay for the brucellosis . Clin Lab 2003; 49:577-

diagnosis of human brucellosis in 589.
surveillance and clinical settings in 10. Queipo-Ortuno MI, Morata P, Ocon
Egypt. Saudi Med J. 2006; 27:975- P, Manchado P, Colmenero JD.
981. Rapid diagnosis of human
5. Baily G, Krahn G, Drasar JB, Stoker brucellosis by peripheral-blood PCR
NG. Detection of Brucella assay. J Clinic Microbiol 1997; 35:
melitensis and Brucella abortus by 2927–2930.
DNA amplification. J Trop Med 11. Morata P, Queipo-Ortuño MI,
Hyg 1992; 95:271–275. Reguera JM, García-Ordoñez MA,
6. Bricker BJ, Halling SM. Cárdenas A, Colmenero JD,
Differentiation of Brucella abortus Development and evaluation of a
bv. 1, 2, and 4, Brucella melitensis, PCR-enzyme-linked immunosorbent
Brucella ovis, and Brucella suis bv. assay for diagnosis of human
1 by PCR. J Clin Microbiol 1994; brucellosis. J Clin Microbios
32:2660-2666. 2003;41:144-148.
7. Ouahrani-Bettach S, Soubrier MP, 12. Alton GG, Jones LM, Angus RD,
Liautard JP. 1S6501- anchored PCR Verger JM, Techniques for the
for the detection and identification Brucellosis Laboratory. 1st Edn.,
of Brucella species and strains. J Institute Nationale de le Rech,
Appl Biotechnol 1996; 81:154-160. France, Paris, 1988. pp: 174
8. Srikantiah P, Girgis FY, Luby SP, 13. Smits HL, Kadri SM. Brucellosis in
Jennings G, Wasfy MO, Crump JA India: A deceptive infectious disease.
Population based surveillance of Indian J Med Res 2005; 122:375-
typhopid fever in Egypt. Am J Trop 384.
Med Hyg 2006; 74:114-119. 14. Moreno S, Ariza J, Espinosa F J.
9. Dahouk SA, Tomaso H, Nockler K, Brucellosis in patients infected with
Neubauer H, Frangoulidis D. the human immunodeficiency virus.
Laboratory based diagnosis of Eur J Clin Microbiol Infect Dis 1998;
brucellosis. A review of literature. 17:319–326.
Part II : Serological test for
15. Shome R, Shome BR, Deivanai M, competitive enzyme immunoassay

Desai GS. Patil SS, Bhure SK, for the diagnosis of bovine
Prabhudas K. Microbiol, Immun brucellosis. Vet Immunol
Infect Dis Seroprevalence of Immunopathol 1995; 46:285–291.
brucellosis in small ruminants. 20. Renukaradhya GJ, Isloor S,
Indian J Comp mirobiol, Rajasekhar M. Epidemiology,
Immunology-infectious disease 2006; zoonotic aspects, vaccination and
27:13-15. control/eradication of brucellosis in
16. World Organization for Animal India. Vet. Microbiol 2002; 90: 183-
Health (OIE). Manual of diagnostic 195
tests and vaccines 2004 [online]. 21. Agasthya AS, S Isloor, K Prabhudas.
Paris: OIE; 2004. Bovine brucellosis. Brucellosis in high risk group
Available at: individuals Indian J Med Microbiol
http://www.oie.int/eng/normes/mma 2007; 25: 28-31
nual/A_00052.htm. Accessed 4 Jun 22. Guarino A, Serpe L, Fusco G,
2007 Scaramuzzo A, Gallo P.. Detection
17. Daniel TM, Debanne SM, Sero of Brucella species in buffalo whole
diagnosis of tuberculosis and other blood by gene-specific PCR. Vet
mycobacterial diseases by enzyme Rec. 2001; 147: 634- 636
linked immunosorbant assay. Am 23. Bricker BJ. PCR as a diagnostic tool
Rev Respir Dis 1987:137: 1137- for brucellosis. Vet Microbiol 2002;
1151. 90: 435–446
18. Carlson, HE, Hurvell B, Lindberg 24. Mantur BG, Akki AS, Mangalgi SS,
AA. Enzymelinked immunosorbent Patil SV, Gobbur RH, Peerapur BV.
assay (ELISA) for titration of Childhood brucellosis - a
antibodies against Brucella abortus microbiological, epidemiological
and Yersinia enterocolitica. Acta and clinical study. J Trop Pediatr
Pathol. Microbiol Immunol Scand 2004; 50:1537.
Sect C 1976; 84:168-176 25. Mantur BG, Biradar MS, Bidri RC,
19. Nielsen KH, Kelly L, Gall D, Mulimani MS, Veerappa, Kariholu P,
Nicoletti P, Kelly W. Improved Protean clinical manifestations and
diagnostic challenges of human thrombocytopenia. Saudi Med J

brucellosis in adults: 16 years' 2000; 21:877-879.
experience in an endemic area. J 31. Khorasgani MR, Esmaeili H,
Med Microbiol 2006; 55:897-903 Pourkarim MR, Mankhian AR,
26. Mathur TN. A study of human Zahraei Salehi T. Anti-brucella
brucellosis based on culture isolated antibodies in blood donors in
from man and animals. Indian J Med Boushehr, Iran. Comp Clinic Pathol
Res 1968; 56: 250-258 2007; 17: 267-269.
27. Handa R, Singh S, Singh N, Wali JP. 32. Nagrathna S, Sharmada S, Veena
Brucellosis in north India: results of kumari HB, Arvind N, Sunder P,
a prospective study. J Commun Dis Sangeeth S. Seroprevalence of
1998; 30: 85-87. Brucella agglutinins: A pilot study.
28. Mrunalini N, Reddy MS, Indian J Pathol Microbiol 2009;
Ramasastry P, Rao MR. 52:457-458.
Seroepidemiology of human 33. Sen MR, Shukla BN, Goyal RK.
brucellosis in Andhra Pradesh. Seroprevalence of brucellosis in and
Indian Vet J 2004; 81:744-747. around Varanasi; J. Commun. Dis
29. Ajay Kumar VJ, Nanu E. 2002; 34:226–227.
Seropositivity of brucellosis in 34. Kadri SM, Rukhsana A, Laharwal
human beings. Indian J Public Healt MA, Tanvir M. Seroprevalence of
2005; 49:22-24. brucellosis in Kashmir (India)
30. Hussain I, Gokul BN, Paul A. among patients with pyrexia of
Brucellosis associated with unknown origin. J Indian Med Assoc
2000; 98:170-171.
ACKNOWLEDGEMENT
We are thankful to Deputy Director General, (Animal Sciences) ICAR, New Delhi for his moral
support and encouragement. The laboratory help from Hanumantharaju B (supporting staff) is
also acknowledged.
CORRESPONDENCE
Vol.1 ● No. 3 ● 2012 Scientific Research Journal of India 52
*Project Directorate on Animal Disease Monitoring And Surveillance, (PD-ADMAS), Hebbal Bangalore-560 024.
Email: [email protected].
** Asst Professor, Dept of Microbiology, Yogi vemana University Kadapa, Andhra pradesh
Study of Non-Isothermal Kinetic of Austenite Transformation to Pearlite in

CK45 Steel by Ozawa Model Free Method
Mohammad Kuwaiti*
Abstract:
In recent years, many researchers have been done about the kinetics of thermal
decomposition processes. In this study, The Ozawa model free method were used to
study the Non-Isothermal kinetic of Austenite Transformation to Pearlite. DTA
o
method was used at cooling rates of 5, 10 and 20
min , under argon atmosphere.
Activation energy as a kinetics parameter was determined by using of Ozawa model
free method. The results show that the Activation energy in Ozawa model free method
is in range of 44.8-45.6 KJ mol .
Keywords: Kinetic, Non-Isothermal, Austenite, Pearlite, Ozawa model, DTA,

Activation Energy.
INTRODUCTION
Heterogeneous chemical reactions are ferrite. In kinetic study of heterogeneous

reactions that the components of reaction reactions, is assumed that the equation of
are in different phases, these phases that rate is also true in the homogeneous gas
make up the interfaces and usually reactions reactions2. In the effect of cooling, in
are performed in interfaces1. Reactions are diagram of equilibrium of Iron – Carbon,
started in Austenite transformation to austenite transformation to pearlite occurs at
3, 4
pearlite from interface of austenite and the temperatures near 727°C . In this
study, Ozawa and Friedman models free energy in the various progresses fraction of
method were used for kinetic of austenite reaction11.
transformation to pearlite in non-isothermal Eα (1)
ln( β i ) = C −
conditions. Using model free methods begin RTα ,i
to investigate non-isothermal kinetics from
In equation 1, C is the constant, Tα ,i is the
60 A. D.5, 6. In model free methods, is
temperature in the fraction of distinguished
assumed that changing rate of heating the
progress, R is the gas constant, β i is
sample, do not change the reaction
mechanism and rate reaction is only a cooling rate and Eα is activation energy in
function of temperature. Today, determining the fraction of reaction progress. For
parameters of kinetics are used by model calculating activation energy in each
free methods and the development of fraction of the distinguished progress (α ) ,
equipment7. On the base, these methods are  1 
8 changing of Ln β i are drawn vs.  
obtained from STA or DTA . Freeman,  Tα‫و‬i 
Carroll to calculation parameters of kinetic,
and the activation energy is calculated
use from equation of gases rate, although
according to slope of the drawn line. Model
these equations are correct from the
of fraction of the converter was proposed by
standpoint of mathematical, but from the
Friedman, in this method, is necessary that
standpoint of practical are excited some
the experiments are performed at least three
limitations9. In addition, Coats and Redfern
different heating rates5. In this method, from
use from the approximation of temperature
Equation 2 is used for calculating the
function in integral equations, although this
activation energy in the various progresses
approximation has some limitation to
fraction of reaction.
convert data into logarithms, but it can be a
suitable method for the evaluation initial of
 dα  (2)
ln βi ( )α  = ln[Af (α )] − ( )α
10 E
the models of kinetic . Ozawa for
 dT  RT
calculating the activation energy proposes
his own method in a fraction of the
In this equation, α is the fraction progress
distinguished converter. In this method,
of reaction, T is the temperature, R is the
equation 1 is used for calculating activation
gas constant, β i is the cooling rate, A is the
pre-exponential factor, f (α ) is the reaction
mechanism and E is the activation energy.
For calculating the activation energy in each

dα
α , changing ln  β i ( ) α  is drawn vs.
 dT 
1 
  and similar Ozawa method, the slope
T 
 α
of the drawn lines, will be determined the
activation energy. In this study, by using
Ozawa and Friedman model free methods,
activation energy of austenite
transformation to pearlite in CK45 steel was Figure 1. Microstructure austenite
transformation to pearlite of CK45 steel a) 500X b)
calculated at cooling rates of 5, 10 and 20 100X
o
C . 50 mg samples of the steel was used for the
min
DTA experiments, by apparatus STA 503,
o
METHOD OF RESEARCH for cooling rates of 5, 10 and 20 C , in
min
The simple of CK45 steel, with the non-isothermal conditions and under argon
specified chemical composition in Table 1, atmosphere. The used range for the DTA
was used as basic material. experiments was 1200 to 650 o C .
Table 1. Chemical composition of CK45 RESULTS AND DISCUSSION

steel used in this study
%S %Mn %C
steel Heat Figure 2 is shown the results of the DTA
treatment
<0.03 0.5-0.8 experiments at cooling rates of 5, 10 and 20
%Si %P 0.42-0.5 CK45 o
C .
<0.4 0.35 min
Figure 1 shows microstructure of the sample

which is used.
fraction progress of reaction vs. time at

different cooling rates.
Figure 3. The fraction progress of reaction

vs. time
In this Method, not only parameter of time

but also temperature is important, values of
the fraction progress of reaction and the
transformation temperatures were calculated
at different cooling rates that are specified
in Table 2.
Table 2. Values of the fraction progress of

Figure 2. Used peaks to calculate the reaction at different cooling rates
fraction progress of reaction of austenite
transformation to pearlite in the cooling 10 C 20
o
fraction min
rates (a) 5, (b) 10 and (c) 20 C . 5C C
min progress min min
of
According to this figure, the start and finish reaction T (o C ) T (o C ) T (o C )
0.0 883 886 679
temperatures of austenite transformation to
0.1 879 882 675
pearlite are calculated and with increasing 0.2 877 881 672
the cooling rate, the starting temperature of 0.3 876 880 672
0.4 875 879 670
transformation is reduced from 883 to 679 0.5 875 878 669
o
C . For calculating the fraction progress of 0.6 874 877 668
0.7 873 876 667
reaction, the area under peak of DTA curve 0.8 872 874 666
calculated at any moment and is divided on 0.9 871 872 665
1 867 867 662
the area of peak total. Figure 3 shows, the
As explained in Equation 1, for Calculating

activation energy in each fraction of
progress should be drawn changing of Ln β i
 1 
vs.   . Table 3 shows the values of
 Tα‫و‬i 
 1 
  for the fraction progress of 1
 Tα‫و‬i  Figure 4. Curves Ln β i vs.   in the
 T α
reaction in various cooling rates. fraction progress of reaction 0.1-0.9
It noticed that the drawn lines are almost

Table 3. The calculated values by the parallel and thus can be concluded that
Ozawa method at different cooling rates
according to Ozawa model, changing the
Fraction fraction progress of reaction did not
progress β =5 β = 10 β = 20
of fluctuate in activation energy. Table 4
1 1 1
reaction       shows the calculated values of activation
 T α  T α  T α
energy by using the Ozawa model, for the
0.1 0.0008679 0.0008654 0.0001054
0.2 0.0008688 0.0008663 0.0001057 fraction progress of reaction.
0.3 0.0008696 0.0008671 0.0001025
0.4 0.0008704 0.0008679 0.0001060 Table 4. The values of activation energy in
0.5 0.0008704 0.0008679 0.0001060 the fraction progress of reaction of austenite
0.6 0.0008713 0.0008688 0.0001062 transformation to pearlite is obtained from
0.7 0.0008721 0.0008696 0.0001063 Figure 4 for the Ozawa method
0.8 0.0008729 0.0008713 0.0001064
0.9 0.0008738 0.0008729 0.0001065 Fraction Activation
progress of Energy( J )
This information has been calculated by reaction mol
using available information in Figure 3. 0.1 45685
0.2 45319
Figure 4 shows changing of Ln β i vs. 0.3 45269
0.4 45228
 1 
  for the austenite transformation to 0.5 45111
 Tα‫و‬i  0.6 44945
0.7 44870
pearlite. 0.8 44870
0.9 44912
On this base, with increasing the fraction of nucleation and growth. Different reports
progress of reaction, reduced activation and models in the cases of kinetic of
energy partially and in addition to Kinetic austenite transformation to pearlite have
barriers that exist in the early stages of been published But the numerical values is
transformation, it is justified. It is important not registered for the activation energy of
that the calculated values of activation this transformation 13-17.
energy is the apparent activation energy of
transformation and can be included stages
REFERENCES
1. W., Christian: The theory of rates”, J. therm. Anal., Vol.27,
transformations in metals and alloys , pp.95-101, 1983.
Pergamon, Oxford, 2002. 7. M ., Enomoto and H.I., Aaronson,
2. L.W., Coudurier, “Thermodynamics "Austenite to Ferrite Transformation
Study of Mo-O-S system”, Trans. Kinetics", Metall.trans. A., Vol.
Inst. Min. Met., C79, pp.34-40, 1970. 12A, pp. 1547-1557, 1986.
3. E., Mortimer: Chemistry, A 8. J.S., Kirlcaldy and Baganis," A
Conceptual Approach, Van computational model for the
Nostrand, New York, 1979. prediction of steel hardenability",
4. D.A., Porter and K.E., Easterling: Metall.trans. A., Vol. 9A , pp.495-
Phase transformations in metals and 501, 1978.
alloys., Chapman&hall, London, 9. E.S., Freeman, B.J., Carroll, “The
1993. Application of Thermoanalytical
5. H., Friedman, "Kinetics of thermal Techniques to Reaction Kinetics:
degradation of char-forming plastics The Thermogravimetric Evaluation
from thermogravimetry. Application of the Kinetics of the Decomposition
to a phenolic plastic", Polym. Sci. J., of Calcium Oxalate Monohydrate”,
Vol.7, pp. 183–195, 1964. Phys. Chem., Vol. 62, pp.394-397,
6. J.H., Flynn, “The isoconversional 1958.
method for determination of energy 10. A.V., Coats and J.P., Redfern,
of activation at constant heating “Kinetic Parameters from
Thermogravimetric Data”, Nature, 15. M., Hillert, " Formation of Pearlite

201, pp.68-69, 1964. Colonies for Simple Models of
11. T., Ozawa, “A New Method of Alloys Iron-Carbon-Mangenise",
Analyzing Thermogravimetric Data”, Jernkont. Ann., Vol.88, p. 130,
Bull. Chem. Soc., Japan., Vol.38, 1962.
pp.1881-1887, 1965. 16. A., Roósz, Z., Gácsi, E.G., Fuchs, "
12. C. W., Wegst: Stahlschlussel, Isothermal formation of austenite in
western, Germany, 1989. eutectoid plain carbon steel ", Acta.
13. M., Hillert, L., Höglund," Reply to Metall., Vol. 31, p.509, 1983.
comments on kinetics model of 17. C., García de Andrés, L.F., Alvarez,
isothermal pearlite formation in a M., Carsí, "Modelling of Kinetics
0.4C–1.6Mn steel ", Scripta Mater, and Dilatometric Behavair of Non-
Vol. 141, p. 46-78, 2003. Isothermal Pearlite-to-Austenite
14. J.S., Kirlcaldy and Baganis," A Transformation in an Eutectoied
computational model for the Steel.", Welding International, Vol.6,
prediction of steel hardenability", p.612, 1992.
Metall.trans. A., Vol. 9A, pp.495-
501, 1978.
CORRESPONDENCE
* Department of Metallurgical Engineering, Islamic Azad University of Najaf Abad University, Iran
Face Exposure Technology

Thanigaivel.V*
Abstract:
The Face recognition is concerned with determining which part of an image contains
a face. If present, return the image location and content of each face. The automatic
system that analyzes the information contained in faces. While earlier works deal
primarily with standing front faces, several systems have been developed that are
able to detect faces reasonably truly plane or out-of-plane rotations in real time.
Even if a face exposure module is normally designed to deal with single images, its
performance can be improved if video capture.
INTRODUCTION
The technology has facilitated the foundation, faces need to be located and
development of real-time visualization registered first to facilitate further
modules that interact with humans. For processing. It is evident that face detection
biometric systems that use faces as non- plays an important and critical role for the
intrusive input modules, it is imperative to success of any face processing systems. The
locate faces in a picture before any face detection problem is testing as it needs
recognition algorithm can be applied. A to account for all possible look difference
vision based user interface should be able to caused by change in lights, facial features,
tell the attention focus of the user in order to occlusions. In addition, it has to detect faces
respond as a result. To detect facial features that appear at different technology, with in
truly for applications such as digital plane revolution. In spite of all these
difficulty, great progress has been made in detected faces are usually further processed
the last decade and many systems have to combine overlapped results and remove
shown inspiring real-time act. The recent false positives with heuristics1 or further
advances of these algorithms have also processing (e.g., edge exposure and
made major help in detecting other objects intensity variance). Numerous
such as humans, representations have been proposed for face
exposure, including pixel-based1, 3, 5, parts-
Face Exposure System based4, 6, 7
, local edge features8, 9, Haar
Most exposure systems carry out the task by wavelets4,10, and Haar-like features2, 11
.
extracting certain properties of a set of While earlier holistic representation
training images acquired at a fixed pose in schemes are able to detect faces1, 3, 5
, the
an off-line setting. To reduce the effects of recent systems with Haar-like features2, 12, 13
illumination change, these images are have demonstrated impressive empirical
processed with histogram equalization1, 3
results in detect faces under occlusion. A
Based on the extracted properties, these large and representative training set of face
systems typically scan through the entire images is essential for the success of
image at every possible location and scale learning-based face detector. From the set
in order to locate faces. The extracted of collected data, more positive examples
properties can be either manually coded or can be synthetically generated by perturbing;
learned from a set of data as adopted in the mirroring, rotating and scaling the original
recent systems that have demonstrated face images1, 3. On the other hand, it is
impressive results1, 2, 3, 4, 5. In order to detect relatively easier to collect negative
faces at different scale, the detection examples by randomly sampling images
process is usually repeated to a pyramid of without face images1, 3. As face exposure
images whose resolution is reduced by a can be mainly formulated as a pattern
1, 3
certain factor (1.2) from the original one . recognition problem, numerous algorithms
Such procedures may be expedited when have been proposed to learn their generic
other visual cues can be accurately templates (e.g., eigenface and statistical
incorporated (motion) as pre-processing distribution) or discriminate classifiers (e.g.,
5
steps to reduce the search space . As faces neural networks, Fisher linear discriminate,
are often detected across scale, the raw sparse network of Winnows, decision tree,
Bays classifiers, support vector machines, like features (at different position and scale)
and AdaBoost). Typically, a good face is very large (about 160,000). Contrary to
detection system needs to be trained with most of the prior algorithms that use one
several iterations. One common method to single strong classifier (e.g., neural
further improve the system is to bootstrap a networks and support vector machines),
trained face detector with test sets, and re- they used an ensemble of weak classifiers
train the system with the false positive as where each one is constructed by
well as negatives1. This process is repeated shareholding of one Haar-like feature. The
several times in order to further improve the weak classifiers are selected and weighted
performance of a face detector. A survey on using the AdaBoost algorithm14. As there is
these topics can be found in5, and the most large number of weak classifiers, they
recent advances are discussed in the next presented a method to rank these classifiers
section. into several cascades using a set of
optimization criteria. Within each stage, an
Recent technology ensemble of several weak classifiers is
The AdaBoost-based face detector by Viola trained using the AdaBoost algorithm. The
and Jones2 demonstrated that faces can be motivation behind the cascade of classifier
fairly reliably detect in real-time (i.e., more is that simple classifiers at early stage can
than 15 frames per second on 240 by filter out most negative examples efficiently,
320images with desktop computers) under and stronger classifiers at later stage are
partial occlusion. While Haar wavelets were only necessary to deal with instances that
used in10 for representing faces and look like faces. The final detector, a 38
pedestrians, they proposed the use of Haar- layer cascade of classifiers with 6,060 Haar-
like features which can be computed like features, demonstrated impressive real-
efficiently with integral image2. Figure 1 time performance with fairly high detection
shows four types of Haar-like features that and low false positive rates. Several
are used to encode the horizontal, vertical extensions to detect faces in multiple views
and diagonal intensity information of face with in-plane ration have since been
images at different position and scale. proposed12, 13, 15. An implementation of the
Given a sample image of 24 by 24 pixels, AdaBoost-based face detector2 can be found
the exhaustive set of parameterized Haar- in the Intel Open CV library. Despite the
excellent run-time performance of boosted selection algorithm used as a pre-computing

2
cascade classifier , the training time of such procedure, they reported that the training
a system is rather lengthy. In addition, the time of the classifier cascade with AdaBoost
classifier cascade is an example of is reduced by 50 to 100 times. For learning
degenerate decision tree with an unbalanced in each stage (or node) within the classifier
data set (i.e., a small set of positive cascade, they also exploited the asymmetry
examples and a huge set of negative ones). between positive and negative data using a
Numerous algorithms have been proposed linear classifier with the assumptions that
to address these issues and extended to they can be modeled with Gaussian
detect faces in multiple views. To handle distributions17. The merits and drawbacks of
the asymmetry between the positive and the proposed linear asymmetric classifier as
negative data sets, Viola and Jones well as the classic Fisher linear discriminate
proposed the asymmetric AdaBoost were also examined in their work. Recently,
algorithm16 which keeps most of the Pham and Champ proposed an online
weights on the positive examples. In 2, the algorithm that learns asymmetric boosted
AdaBoost algorithm is used to select a classifiers18 with significant gain in training
19
specified number of weak classifiers with time. In , an algorithm that aims to
lowest error rates for each cascade and the automatically determine the number of
process is repeated until a set of classifiers and stages for constructing a
optimization criteria (i.e., the number of boosted ensemble was proposed. While a
stages, the number of features of each stage, greedy optimization algorithm was
and the detection/false positive rates) is employed in 2, Brubaker et al. proposed an
satisfied. As each weak classifier is made of algorithm for determining the number of
one single Haar-like feature, the process weak classifiers and training each node
within each stage can be considered as a classifier of a cascade by selecting operating
feature selection problem. Instead of points within a receiver operator
20
repeating the feature selection process at characteristic (ROC) curve . The solved the
17
each stage, Wu et al. presented a greedy optimization problem using linear programs
algorithm for determining the set of features that maximize the detection rates while
for all stages first before training the satisfying the constraints of false positive
cascade classifier. With the greedy feature rates19. Although the original four types of
Haar-like features are sufficient to encode which consists of a series of detectors

upright frontal face images, other types of trained with positive images only, and the
features are essential to represent more energy-based method25 that simultaneously
complex patterns (e.g., faces in different detects faces and estimates their pose in real
11,12,13,15,21
pose) . Most systems take a divide- time.
and-conquer strategy and a face detector is
constructed for a fixed pose, thereby Quantifying Performance
covering a wide range of angles (e.g., yaws There are numerous metrics to gauge the
and pitch angles). A test image is either sent performance of face detection systems,
to all detectors for evaluation or to a ranging from detection frame rate, false
decision module with a coarse pose positive/negative rate, number of classifier,
estimator for selecting the appropriate trees number of feature, and number of training
for further processing. The ensuing image, training time, accuracy and memory
problems are how the types of features are requirements. In addition, the reported
constructed, and how the most important performance also depends on the definition
ones from a large feature space are selected. of a “correct” detection result1, 5. Figure 2
More generalized Haar-like features are shows the effects of detection results versus
defined in11, 12
in which the rectangular different criteria, and more discussions can
image regions are not necessarily adjacent, be found in1, 5. The most commonly adopted
and furthermore the number of such method is to plot the ROC curve using the
rectangular blocks is randomly varied11. de facto standard MIT + CMU data set 1
Several greedy algorithms have been which contains frontal face images. Another
proposed to select features efficiently by data set from CMU contains images with
exploiting the statistics of features before faces that vary in pose from frontal to side
training boosted cascade classifiers17, 21
. view4. It has been noticed that although the
There are also other fast face detection face detection methods nowadays have
methods that demonstrate promising results, impressive real-time performance, there is
including the component-based face still much room for improvement in terms
4
detector using Naive Bays classifiers , the of accuracy. The detected faces returned by
face detectors using support vector state-of-the-art algorithms are often a few
7, 22, 23 24
machines , the Anti-face method pixels (around 5) off the “accurate”
locations, which is significant as face images alone. The research will focus on
images are usually standardized to 21 by 21 improvement of detection precision for face
pixels. While such results are the trade-offs exposure.
between speed, robustness and accuracy,
they inevitably degrade the performance of Adaptive Boosting
any biometric applications using the The Adaptive Boosting) is a machine
contents of detected faces. Several post- learning algorithm formulated by Freund
processing algorithms have been proposed and Shapiro14 that learns a strong classifier
to better locate faces and extract facial by combining an ensemble of weak
features (when the image resolution of the classifiers with weights. The discrete
detected faces is sufficiently high)26, 27. Adaptive Boosting algorithm was originally
developed for classification using the
Applications exponential loss function and is an instance
As face detection is the first step of any face within the boosting family.
processing system, it finds numerous
applications in face recognition, face Hear-like features
tracking, facial expression recognition, Similar to the what Haar wavelets are
facial feature extraction, gender developed for basis functions to encode
classification, clustering, attentive user signals, the objective of two-dimensional
interfaces, digital cosmetics, biometric Haar features is to collect local oriented
systems, to name a few. In addition, most of intensity difference at different scale for
the face detection algorithms can be representing image patters. This
extended to recognize other objects such as representation transforms an image from
cars, humans, pedestrians, and signs, etc5. pixel space to the space of wavelet
coefficients with an over-complete
Summary dictionary of features. The Haar-like
The advance in face exposure has created a features, similar to Haar wavelets, compute
lot of exciting and reasonably applications. local oriented intensity difference using
As most of the algorithms can also be rectangular blocks (rather than pixels)
applied to other problem domains, it has which can be computed efficiently with the
broader impact than detecting faces in integral image2.
of examining all scanned image patches can

Receiver operating characteristic be reduced significantly.
A receiver operating characteristic is a plot
p
commonly used in machine learning and
data mining for exhibiting the performance
of a classifier under different criteria. The y-
y
(a) Face images (b)Non-face images
axis is the true positive and the xx-axis is the
Fig. 1. Four types of Haar
Haar-like features.
false positive (i.e., false alarm). A point on
These features appear at different position
operating characteristic shows
sho that the
and scale.The Haar
Haar-like features are
trade-off
off between the achieved trues
computed as the difference of dark and light
positive detection rate and the accepted
regions. They can be considered as features
false positive rate.
that collect local edge information at
different orientation and scale. The set of
Classifier cascade
Haar-like
like features is large, and only a small
In face detection, a classifier cascade is a
amount of them are learned from positive
degenerate decision tree where each node
and negative
ive examples for face detection.
(decision stump) consists of a binary
classifier. In 2, each node is a boosted
classifier consisting of several weak
classifiers. These boosted classifiers are
constructed so that the ones near the root
(a) Test image (b)Detection results
can be computed very efficiently at very
Fig. 2. Detection results depend heavily on
high detection rate with acceptable false
the adopted criteria. Suppose all the sub-
sub
positive rate. Typically, most patches in a
images in (b) are returned as face patterns
test image can be classified as faces/non
faces/non-
by a detector. A loose criterion may declare
de
faces using simple classifiers near the root,
all the faces as “successful” detections
and relatively few difficult ones need to be
while a more strict one would declare most
analyzed by nodes with deeper depth. With
of them as non
non- faces.
this cascade structure, the total computation
REFERENCES
1. Rowley, H., Baluja, S., Kanade, T.: 7. Heisele, B., Serre, T., Poggio, T.: A
Neural network-based face detection. IEEE component-based framework for face
Transactions on Pattern Analysis and detection and identification. International
Machine Intelligence 20(1) (1998) 23–38 Journal ofComputer Vision 74(2) (2007)
167–181
2. Viola, P., Jones, M.: Robust real-time
face detection. International Journal of 8. Amit, Y., Geman, D.: A computational
Computer Vision 57(2) (2004) 137–154 model for visual selection. Neural
Computation 11(7) (1999) 1691–1715
3. Sung, K.K., Poggio, T.: Example-based
learning for view-based human face 9. Fleuret, F., Geman, D.: Coarse-to-fine
detection. IEEE Transactions on Pattern face detection. International Journal of
Analysis and Machine Intelligence 20(1) Computer Vision 41(12) (2001) 85–107
(1998) 39–51
10. Papageorgiou, C., Poggio, T.: A
4. Schneiderman, H., Kanade, T.: Object trainable system for object recognition.
detection using the statistics of parts. International Journal of Computer Vision
International Journal of Computer Vision 38(1) (2000) 15–33
56(3) (2004)151–177
11. Dollar, P., Tu, Z., Tao, H., Belongie, S.:
5. Yang, M.H., Kriegman, D., Ahuja, N.: Feature mining for image classification. In:
Detecting faces in images: A survey. IEEE Proceedings of IEEE Conference on
Transactions on Pattern Analysis and ComputerVision and Pattern Recognition.
MachineIntelligence 24(1) (2002) 34–58 (2007)
6. Mohan, A., Papageorgiou, C., Poggio, T.: 12. Li, S., Zhang, Z.: Floatboost learning
Example-based object detection in images and statistical face detection. IEEE
by components. IEEE Transactions on Transactions on Pattern Analysis and
PatternAnalysis and Machine Intelligence Machine Intelligence28(9) (2004) 1112–
23(4) (2001) 349–361 1123
13. Huang, C., Ai, H., Li, Y., Lao, S.: High- object detection. In: Proceedings of IEEE
performance rotation invariant multiview Conference on Computer Vision and Pattern
face detection. IEEE Transactions on Recognition. (2007)
PatternAnalysis and Machine Intelligence
29(4) (2007) 671–686 19. Brubaker, S.C., Wu, J., Sun, J., Mullin,
M., Rehg, J.: On the design of cascades of
14. Freund, Y., Schapire, R.: A decision- boosted ensembles for face detection.
theoretic generalization of on-line learning International Journal of Computer Vision
and application to boosting. Journal of 77(1-3) (2008) 65–86
computer andsystem sciences 55(1) (1997)
119–139 20. Provost, F., Fawcett, T.: Robust
classification for imprecise environments.
15. Jones, M., Viola, P.: Fast multi-view Machine Learning 42(3) (2001) 203–231
face detection. Technical Report TR2003-
96, Mitsubishi Electrical Research 21. Pham, M.T., Cham, T.J.: Fast training
Laboratories (2003) and selection and Haar features using
statistics in boosting-based face detection.
16. Viola, P., Jones, M.: Fast and robust In: Proceedings of IEEE International
classification using asymmetric Adaboost Conference on Computer Vision. (2007)
and a detector cascade. In: Advances in
Neural Information Processing Systems. 22. Oren, M., Papageorgiou, C., Sinha, P.,
(2002) 1311–1318 Osuna, E., Poggio, T.: Pedestrian detection
using wavelet templates. In: Proceedings of
17. Wu, J., Brubaker, S.C., Mullin, M., IEEE Conference on Computer Vision and
Rehg, J.: Fast asymmetric learning for Pattern Recognition. (1997) 193–199
cascade face detection. IEEE Transactions
on Pattern Analysis and Machine 23. Romdhani, S., Torr, P., Sch¨olkopf, B.,
Intelligence 30(3) (2008) 369–382 Blake, A.: Computationally efficient face
detection. In: Proceedings of the Eighth
18. Pham, M.T., Cham, T.J.: Online IEEE International Conference on
learning asymmetric boosted classifiers for
Computer Vision. Volume 2. (2001) 695– model and its application to analysis of
700 facial images. IEEE Transactions on Pattern
Analysis and Machine Intelligence 5(28)
24. Keren, D., Osadchy, M., Gotsman, C.: (2006) 73800752
Antifaces: A novel fast method for image
detection. IEEE Transactions on Pattern 27. Ding, L., Martinez, A.: Precise detailed
Analysis and Machine Intelligence 23(7) detection of faces and facial features. In:
(2001) 747–761 Proceedings of IEEE Conference on
Computer Vision and Pattern Recognition.
25. Osadchy, M., LeCun, Y., Miller, M.: (2008)
Synergistic face detection and pose
estimation with energy-based models. 28. Friedman, J., Hastie, T., Tibshirani, R.:
Journal of Machine Learning Research Additive logistic regression: a statistical
(2007) 1197–1214 view of boosting (With discussion and a
rejoinder by the authors). The Annals of
26. Moriyama, T., Kanade, T., Xiao, J., Statistics 28(2) (2000) 337–407
Cohn, J.: Meticulously detailed eye region
CORRESPONDENCE
*Centre for Research and Development. PRIST University, India. E-Mail:[email protected]
Recovery of Decayed Species through Image Processing
K.Priyadharsan*, S.Saranya**
Abstract:
The problem of rebuilding a structure from decayed remains has been, until now,
especially relevant in the ambit of forensic sciences, where it is obviously oriented
toward the identification of unrecognizable corpses; but its potential interest to
archaeologists and anthropologists is not negligible. This paper is about recovering
the decayed species’ structure, through Spiral Computed Tomography data and
virtual modeling techniques (in this case with VTK software), 3-D models of the
possible physiognomy of ancient mummies. The species representation is based on
3D models and soft tissues are reconstructed.Isosurfaces generation is based on
Marching cubes algorithm. The resulting voxel models are converted into 3d
wrapped models that are coded using VTK software. The presented results iiustrate
that based on the proposed methods a complete recovery of decayed structure can be
built with less cost.
Keywords: VTK, CT,3-D
INTRODUCTION
Reconstruction is an important key feature amount of information not only about the
of image processing applications. It uses CT mummy and its skeleton, but also about the
scanning’s numbers allowed a very fine artifacts buried with the mummy and its
discrimination between materials with coffin2. Compared to traditional x-ray
different densities providing an enormous techniques, multiple axial images displayed
in a clearer way the different details of car The anthropological study of the
tonnage, wrappings, amulets an
and internal mummified cranial remains allowed us to
3
organs of a mummy and allowed easy identify a male subject with an age at death
measurements of exact distances between of around 40 years. The skull is
objects inside or outside the mummy. In the dolichocranic, of medium height and with
last years, spiral CT has considerably rounded occiput, narrow face, high
enhanced clinical imaging. The use of this cheekbones,
bones, gracile even if well developed
new technique has fatherly widened the in its height, jaw; the orbits are narrow, the
range and quality of possible
possi investigations nose is well-shaped,
shaped, and of Europoid look.
on mummies.
So far, related work only considered initial 2. Spiral CT Scanning
representation of the fossil using CT
scanning. Soft tissue reconstruction and
texture mapping has to be studied in detail.
In my paper, surface is constructed using
Marching cubess algorithm and some
changes are made to the existing aalgorithm
to get better results. 3D models are wrapped
and coded using VTK software
This process is organized as follows. In the
next section, I describe the process of Fig. 2 CT scanning of the head
anthropological and egyptological analysis

The cranial cavity was filled with hot
of the head. Section 2 presents spiral CT of
melted resin, later solidified, introduced
the head. Section 3 presents. Reconstruction
with the mummy resting on its back, as the
of a 3-D
D model of the skull generated from
model reconstructed from the CT images
CT data processing. Section 4 presents
clearly displays.
application of textures fitting the somatic
features.
3. Reconstruction of a 3D Model of the
Skull
1. Preliminary Anthropological
thropological Results
CT slices must be stacked up and
interpolated in order to build a volume.
Once created a volume, it is possible, by This stage of our work is still in a

means of suitable algorithms, to generate preliminary phase. Among the possible
surfaces whose points have the same methodologies to deal with this complex
function value. They are called is surfaces A problem, I focused two different promising
popular algorithm for determining is ways:
surfaces is the so called marching cubes. A. Protocols
rotocols developed to the reconstruction
The principle underlying the application
applica of of soft tissues on skull
this algorithm to the kind of problem here B. Use of warping techniques.
t
described is that similar materials have the
same radio-opacity
opacity and are, consequently, A. The thickness of the soft tissues is
represented in a CT scan by the same reconstructed on the bones through the use
densitometry level. In CT slices, the of pegs at marked points. All the pegs are
intensity associated to each pixel in the joined by strips of plotline of fixed
grey-scale
scale is proportional to tissues density: thickness and the empty spaces among them
black corresponds to air, white to bones. It are then slowly filled with mould able
is therefore possible processing the CT material: in this way, it is possible to
scans sequence so as to obtain a 3-D
3 grid, reconstruct nearly all the face that belonged
where to each "knot" (control point) is to the living subject; on this, nose cartilage,
associated the densitometry value measured eye globes and lips are added.
by the CT scans. The result is a 33-D 256
grey levels image. B. A different method consists in the
distortion (warping) of the 33-D model of a
reference
ce scanned head, until its hard tissues
match those of the mummy. The subsequent
stage is the construction of the hybrid model
composed by the hard tissues of the
mummy plus the soft ones of the reference
Fig. 3 a) hard tissues b) external surface head.
4. Reconstruction off Soft Tissues 5. Textures Fitting the

t Somatic Features
While hard and soft tissues give

morphological information, textures provide
colours and aesthetical features. They are
"pasted" over the 3D models by means of
mapping procedures. Moreover, being a
frontal view, it does not give sufficient
Fig.6Lateralview
information for the mapping of the entire
Development of the project: soft tissue
model. We get a low resolution image (fig4).
reconstruction using VTK
After a first part of work, open problem is to
reconstruct the lacking elements of a 3D
digital model generated from CT scans
applied to a mummified cranial remains.
The aim is to obtain a perfect match among
Fig 4 low resolution image
hard tissues so that soft tissue of reference
The texture was mapped onto the 3D model
model can be used to represent those of the
to perfectly match the frontal view of the
mummy with a good approximation.
mummy but it loses its grain as soon as we
Moreover a tool is developed in order to
depart from the frontal view. Much better
apply to the model cylindrical textures
results could be obtained with different high
obtained multiple views of a well suited
resolution views of a new subject.
individual Software implementation has
been designed using VTK.
Cylindrical textures obtained multiple views
of a well suited individual Software
implementation has been designed using
VTK.
Fig 5texture, processed and colored, is CT scans data representing our model and
mapped onto the 3-D model. mummy should have the same placing,
orientation, dimensions and resolution. This
is generally not true especially when dealing
with data coming from different machine so
the first step is to perform a manual

registration (Figure 3), that is a rigid
transformation, among volumes in order to
work in the same system of coordinates.
Software like AIR are also available for
automatic registration but sometimes,
especially when volumes are quite different,
they do not produce satisfactory results.
As further requirement grayscales of hard
tissues must be similar, in spite of different
methodologies of acquisition though
Fig.6 Manchester points placed over the
mummy’s tissues has been deteriorated. It is
mummy
possible to correct these differences shifting
Calculating vector displacement among
and scaling intensities using histogram
couples of corresponding points we obtain a
information.
scattered field to drive a first warp phase. A
For volume resembling, smoothing (to
feature tracking consists in determining a
remove aliasing phenomena) and surface
correspondence between sets of
generation Vtk internal facilities are used.
characteristic points pertaining to the
At this point we precede with the setup of
volumes in order to obtain a scatter motion
the Manchester pegs onto the surface of the
field with more details. It is the most
hard tissues of the mummy while for the
important step.
reference model it can be predetermined.
Initially this set of points is chosen as a
The aim of this phase is to fix some
subset of points that are vertices of hard
constraints for the resulting physiognomy
tissues surface of the mummy; some of
and to provide a first guess for the following
these points, corresponding position in the
step that is the features tracking.
reference volume. If the result is good, the
Pegs are mapped onto a spherical surface of
resulting motion field is defined among
parametric ratio, so that the user can place
subsets of bone surfaces, with particular
quickly the whole set and the adjust single
characteristics, are identified as features.
pegs.
If, consecutively a test, a feature is retained
reliable, we search the from the reference
model to the mummy volume..….

Once generated a scattered motion field, it
must be diffused within the whole reference
volume. Diffused motion field can be used
to warp
arp every structure pertaining to Fig .9 Model skin (blue) and mummy skull
reference model coherently with mummy (white)
model therefore we reconstruct mummy soft
tissues warping those of reference model
Fig 10 Face generated
We consider the relation between hard

tissues surface of the reference model and
Fig 7 wrap driven by manchester points hard tissue surface of the mummy as a
continuous deformation in the time.
If is the intensity of a point

of coordinates (x,y,z) at time t in the
mummy volume
and
is the motion
m field,
where ,
e are components in x, y e z
directions of velocity vector, we suppose
that the intensity function is the same at the
time in the
Fig.8 Model skull (blue) after this stage
overlapped with mummy skull (white) point of the
reference model, we can write the 3 as
where , (5)
e and . Known as motion field constraint equation,
(1) where Ex, Ey, Ez ed Et are partial
derivatives.
We say that x is a reliable feature if
If the intensity function change smoothly
sm
(6)
with x, y, z e t, we can manipulate the
equation (1) with Taylor’s series to obtain
(2)
Where:
I( , t) is the matrix of intensity function
where e contains terms in x, y, z e t E in the point =(x,y,z) in the region W(x)
higher than first order. at the time t;
 is the gradient operator;
Eliminating , rationing by t,  min ()) represents the smaller eigenvalue
and calculating limit for , we of matrix  ;
obtain
are predetermined thresholds.
(3)
We consider a window (q) centered in q
of dimensions.
We represent (6) in discrete fashion
that is the totally derivative of in the
(7)
time.
(4)
Using abbreviated notation: The solution of (4) respect to V is given
by In this moment this stage is still in
developing so we have no picture, anyway
the idea is simple: for each of the
Manchester points we
w find its corresponding
on the skin surface, in this way we can amount of data, was to process and visualize
measure the actual soft tissue thickness. By in real time and in 3D the data volume.
consulting the thickness table we find the Through this paper I hope that this method
corresponding desired thickness measure. will be a useful one to the society.
Saying that the actual thickness must
become the desired thickness we generate REFERENCES
another scattered field. 1. S.B. Kang, R. Szeliski, and P.
Anandan, “The Geometry-Image
Texture Application Representation Trade off for
Rendering”, Proc. ICIP, Vancouver,
Canada, September 2000.
2. P. Eisert, E. Steinbach, and B. Girod,

“Multi-hypothesis, Volumetric
Reconstruction of 3-D Objects. Proc.
ICASSP, pp. 3509-3512, Phoenix,
Mar. 1999.
3. W. E. Lorensen, and H. E. Cline,

“Marching Cubes: A high resolution
CONCLUSION: 3D surface reconstruction algorithm,”
In this paper, for obtaining better Proc. SIGGRAPH, vol. 21, no. 4, pp
performances through the virtual 3D 163-169, 1987.
visualization of the reconstruction i have
used the powerful workstation Onyx2 4. P. Debevec, C. Taylor, and J. Malik,
equipped with an architecture of type “Modeling and rendering
multiprocessor, with 4 processors R10K, 1 architecture from photographs: A
Gbyte of RAM, computing power of 1.5 hybrid geometry image based
Gflop, 1 graphic pipeline, that it can process approach,” Proc. SIGGRAPH, pp.
11 millions of polygons per second. In fact 11-20, 1996.
the main problem, processing a large
CORRESPONDENCE
*DR-DO Project Assistant, Centre for R&D, PRIST University, Thanjavur, India. Email:
[email protected]. **Lecturer, Department of Comp Science & Engg, Bharadhidasan University,
Trichy, India. Email: [email protected]
Call for Papers

Publication.

Volume: 1 » No: 4 » Year: 2012
ISSN » 2277-1700
SRJI
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Scientific Research Journal of India (SRJI)

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Index
Dr. Krishna N.
Editorial 5
Sharma
Comparison of Clinic and Home Based Bijender Sindhu,

Exercise Programs after Total Knee Dr.Manoj Sharma, 7
Arthroplasty: A Pilot Study Dr.Raj K Biraynia
Dharam Pani
Electrical Muscle Stimulation (EMS)
Pandey, Dr. Uday
Improve Functional Independence in 19
Shankar Sharma, Dr.
Critically Ill Patients
Ram Babu
A Comparative Study on Supervised

Bijender Sindhu,
Clinical Exercise versus Home Based
Dr.Manoj Sharma, Physiotherapy 27
Exercise in Primary Unilateral Total
Dr.Raj K Biraynia
Knee Arthroplasty
Comparison of the Effect of Isometric

Exercise of Upper Limb on Vitals Pranjal Parmar 37
between Young Males and Females
Paraplegia with Sacral Pressure ulcer

Shanmuga Raju P.,
treated by Ultrasound therapy- A 50
Ramalingam P.
Single Case Report
Anil Degaonkar,
Arterio-Enteric Fistula: A Case Report Nikhil Bhamare, Surgery 57
Mandar Tilak
All-Oxide Solar Cells: The Way of the Akshay Vijay Chemical

63
Future Dongarwar Engineering
Editorial
Dear Readers,
I am very pleased to present the fourth issue of the Scientific Research
Journal of India (SRJI) as the next Editor in Chief. This multidisciplinary and
open access Journal of science is the official organ of Dr. L. Sharma Medical
Care and Educational Development Society. The previous issues had covered
three disciplines of science Physiotherapy, Agriculture, Anthropology and
Computer science. In this current issue we are covering two new branches of
science- Surgery, and Chemical Engineering. I would like to mention that this
journal is intended to publish selected original research articles, reviews, short
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Comparison of Clinic and Home Based Exercise Programs after Total

Knee Arthroplasty: A Pilot Study
Bijender Sindhu PhD, PT*, Dr.Manoj Sharma, MBBS, MS(Ortho)**, Dr.Raj K Biraynia, MBBS,
D.Ortho***
Abstract: Sixteen patients (mean age, 68+-8 years) having primary total knee
arthroplasty were assigned randomly to two rehabilitation programs: (1) clinic-
based rehabilitation provided by outpatient physical therapists; or (2) home-
based rehabilitation monitored by periodic telephone calls from a physical
therapist. Both rehabilitation programs emphasized a common home exercise
program. Before surgery, and at discharge and follow up after surgery, no
statistically significant differences were observed between the clinic and the
home-based groups on any of the following measures: (1) total score on the Knee
Society clinical rating scale; (2) total score on the ILOA level of assistance (3)
total score on the Goniometry; (4) total score of VAScale. After primary total
knee arthroplasty, patients who completed a home exercise program (home-based
rehabilitation) performed similarly to patients who completed regular outpatient
clinic sessions in addition to the home exercises (clinic-based rehabilitation).
Additional studies need to determine which patients are likely to benefit most
from clinic-based rehabilitation programs.
Key Words: Total Knee Arthroplasty, Home Based Exercise Program, Clinic
Based Exercise Program
INTRODUCTION
The aim of the arthroplasty is to resurface support and motivation. Home-based
the tibiofemoral joint to allow better programs, however, typically do not
articulation and to reciprocate normal require the patient to attend outpatient
kinematics of the knee (Palmer & clinic sessions or require attendance at a
Cross,2004) Another aim of surgeons is to minimum number of outpatient sessions,
correct valgus deformity through the and provide fewer opportunities for
release of lateral structures (Elson & monitoring or program modification.
Brenkel, 2006). The most common Although usually developed by and taught
approach is the medial parapatellar to patients by physical therapists, home-
approach. This has been shown to give based exercises typically are completed
better radiological results, but more pain independently by the patient at home.
in the short term than the minimally The populations examined in those studies
invasive mid-vastus approach (Chen, have tended to be younger individuals
2006). Soft tissue and bony alignment can who otherwise were healthy, and with an
be ensured using the Tensor/ Balancer interest in returning to work or sporting
system (Winemaker, 2002). The Tensor/ activities or both. The efficacy of clinic-
Balancer system is important as and home-based rehabilitation programs is
malalignment can lead to failure of the particularly important with respect to
operation (Winemaker,2002) Prostheses elderly patients. Owing to the older age of
consist of a femoral and tibial component. patients who have total knee arthroplasty,
The femoral or tibial component can be the likelihood of complicating medical
cemented, hybrid (one component conditions, the serious implications of
cemented and the other uncemented) or postoperative complications in this
uncemented (Zavadak et al., 1995). The population,and the medicolegal climate,
type of prosthesis used depends on the surgeons may be hesitant to prescribe non
surgeons’ protocol.This question is clinically based rehabilitation programs
important because of time and cost after hospital discharge. An often used
differences between these service delivery alternative to mandatory outpatient
settings. Clinic-based programs typically physical therapy has been having all
are provided by outpatient physical patients complete a limited number of
therapy clinics, and facilitate monitoring clinic visits. Another alternative may be a
the patient’s progress, modifying home-based program, monitored via
individual programs, and providing patient periodic telephone calls. Monthly phone
calls by therapist individuals were or major neurologic conditions were

associated with increased function in excluded.
patients with osteoarthritis. Although Randomization to Groups
caution must be exercised in generalizing At the time of primary total knee
the findings of their study, home exercise arthroplasty, 32 patients were assigned
programs developed and monitored by randomly to two rehabilitation programs
physical therapists via periodic phone (1) clinic-based rehabilitation provided by
calls may provide an alternative to outpatient physical therapy clinics; or (2)
mandatory clinic-based programs and to home-based rehabilitation, monitored by a
requiring a defined number of clinic visits, physical therapist via periodic telephone
and a means to provide some monitoring calls.
of patients during the early rehabilitation
phase. Inpatient and Home Exercise.
Familiarization Period
Objective of the Study: All Objective
patients received standard inpatient
of the Study:
The purpose of the current study was to physical therapy twice daily, for 20
compare two rehabilitation programs after minutes on each occasion. Inpatient
total knee arthroplasty: (1) clinic-based physical therapy also included instruction
rehabilitation delivered in outpatient in a series of home exercises to be
physical therapy clinics; and (2) home- completed daily after discharge, regardless
based rehabilitation monitored by a of the patient’s group assignment.
physical therapist via periodic telephone Ambulatory status on the surgical side
calls, on disease-specific, joint-specific, was weight bearing as tolerated on
and functional outcome measures. discharge after surgery, at which time the
patient progressed to walking with walker.
MATERIAL AND METHODS Discharge criteria included the ability to
Inclusion and Exclusion Criteria transfer independently, ambulate more
Patients were selected using the following than 30 m using walker/crutches, and
criteria: patients having primary unilateral ascend and descend at least five steps.
total knee arthroplasty as a result of Medication given at discharge was pain
osteoarthritis, both male and female who killer, nutrition’s and antibiotics.
had a primary unilateral TKA, age 50-85. Common Home Exercises (for both
Able to give independent informed groups)
consent. Patients with rheumatoid arthritis
The common home exercise program was Group A physical therapist familiar with
that developed for routine total knee the common home exercises telephoned
arthroplasty rehabilitation at the authors’ each patient in the home-based group at
institution, and consisted of basic (Stage 1) least two times ask whether the patient
and more advanced (Stage 2) ROM and was having any problems with the
strengthening exercises. Each patient exercises, to remind them of the
received Stages 1 and 2 booklets, which importance of completing the exercises,
included written and pictorial descriptions and to provide advice on wound care, scar
of each exercise and educational treatment, and pain control. During each
information on using ice, controlling telephone call, which lasted approximately
swelling, walking, and ROM. They were 10 minutes, the patient was asked when
instructed to complete the common home and how often he or she wished to be
exercises three times daily until their 8- telephoned in the future. Patients also
week follow up, at which time they were were provided with a contact telephone
advised to continue the home exercises at number to call if additional questions
least once daily, indefinitely. Home-Based arose.
Variable Clinic-Based Home-

(n=16) Based(n=16)
Continuous variables: mean (standard deviation)
Age (years) 65.2 (6.9)* 64.6 (7.8)
Height (cm) 160.2 (9.6) 162.3 (11.1)
Mass (kg) 86.4 (15.6) 85.5 (15.9)
Disease duration (years) 9.8 (6.4) 9.2 (7.3)
Discrete variables: frequency and percent of group
(percent)
Gender—female 9 (56.25%) 5 (31.25%)
Left replacement 6 (37.5%) 3 (18.75%)
Contralateral knee involvement 8 (50%) 6 (37.50%)
Contralateral hip involvement 3 (18.75%) 1 (6.25%)
Ipsilateral hip involvement 1 (6.25%) 0 (0%)
Table 1. Patient Baseline Characteristics for the Clinic- and Home-Based Groups
Clinic-Based Group In addition to the common home exercises,

patients in the clinic-based group were
required to attend outpatient physical Fig 1. The study time-sequence flow chart
is shown. Patients in both rehabilitation
therapy after discharge to 8 weeks after
groups completed the common home
surgery, for as many as three sessions per exercises daily between Weeks 2 to 8.
week, for approximately 1 hour per
Assessments and Measurements
session. Outpatient physical therapists
In conjunction with routine orthopaedic
were provided with copies of the Stages 1
clinic evaluations pre surgically, and at
and 2 exercise booklets, and were asked to
discharge, 8 weeks after surgery, patients
use these exercises as the basic component
completed a series of questionnaires and
of their rehabilitation program. However,
functional tests that required
they were not advised that the patient was
approximately 1 hour. Throughout the
participating in a study comparing two
study, these tests were conducted by two
rehabilitation programs. Therapists were
experienced testers who were blinded as
permitted to modify or add exercises, use
to the patient’s group assignment, and
therapeutic modalities (such as ice, heat,
gave the test results directly to the study
and ultrasound), joint mobilizations, or
coordinator. The following tests were
other measures as they deemed
completed: (1) total score on the Knee
appropriate. Patients in the clinic-based
Society clinical rating scale; (2) total score
group were requested to complete the
on the ILOA level of assistance (3) total
common home exercises at home only
score on the Gonioetry; (4) total score of
twice on days that they attended clinic
VAScale. From a position of maximum
sessions.
extension, the patient slid the heel of the
Eligibility
Randomization
test leg toward the buttocks to a position
Clinic Based
Rehabilitation
Home Based of maximum knee flexion. The knee angle
Rehabilitation
Total Knee Arthroplasty

was measured using a goniometer and
Inpatient Physical Therapy
Common Home Exercise
Hospital Discharge at 5-7 days
scored as the average of three repetitions.
Atleast 1
telephonic call
OPD 3 session Non directional, t tests, and tests of the
/week at 1
by therapist hour
significance of the difference between two
Stage 2
4 week follow up
Instruction common home
percentages were used to compare the
exrecise
clinic- and home-based groups on pre
OPD 2 session
Atleast 1 /week at 1
telephonic call
by therapist
hour surgical descriptive measures, and to
Stage 3 compare the patients who were lost to, or
8 week follow up
Instruction common home
exrecise dropped out of the study with those who
remained in the study, on baseline
measures. Four-way analysis of variance three times of measurement (before
(ANOVA) were used to examine the surgery, and discharge and 6 weeks after
following four criterion variables(1) total surgery). In view of the number of
score on the Knee Society clinical rating statistical tests computed and to minimize
scale; (2) total score on the ILOA level of the likelihood of Type 1 or alpha error, the
assistance (3) total score on the Gonioetry; 0.01 level was used to denote statistical
(4) total score of VAScale. After a significance throughout analyses.
significant F-ratio, the Newman-Keuls
technique was used to compare selected RESULT
means. Before surgery, no significant differences
Any patients who were removed from were observed between the clinic- and the
their assigned group by the surgeons for home based groups on the demographic
reasons related to the surgically treated variables shown in Table 1, or on any of
knee or medical conditions not related to the nine criterion measures (p>0.01). No
the surgically treated knee, or who statistically significant differences were
withdrew consent to participate, were observed between the patients lost and
encouraged to continue with the home those who remained in the study (Table 2),
exercises and any other therapies or between the patients lost to the two
prescribed, and to continue coming for groups on the baseline scores for any of
regular follow ups and testing. To take the four criterion measures, or for age,
into account that some patients were height, and weight (p>0.01). Length of
removed or otherwise lost from their stay in the hospital for the patients who
group, but did continue to be tested at completed the study in their assigned
their regular follow ups, two types of group was 5.1+-1.5 and 5.2+-1.7 days for
analyses were completed: (1) a per the home- and clinic-based groups,
protocol analysis, which included all respectively. On ANOVA tests, the per
patients who completed the study in their protocol and the intent to treat analyses
assigned group; and (2) an intent to treat produced identical results for all nine
analysis, in which all patients were criterion measures; no treatment, surgeon,
analyzed as having remained in their or prosthesis-related effects were observed
assigned group, regardless of whether they (p>0.01), and only the main effect for time
had completed the study in that group. (averaged over treatment, surgeon) was
Analysis of variance tests were confined significant (p<0.01) (Figs 2, 3).
to patients who had full data sets for the Subsequent analysis of the main effect for
time indicated that the scores before and 8 weeks after surgery (p<0.01),
surgery, at discharge after surgery, and 6 whereas there was no statistically
weeks after surgery differed significantly significant difference (p>0.01) between
from one another (p<0.01); with one the pain scores at discharge and 8 weeks,
minor exception. Pain before surgery, on the per protocol and the intent to treat
measured via Visual analog score, was analyses.
significantly greater than that at discharge
Patient Losses Clinic Based Home Based

(n=16) (n=16)
Patients lost during the inpatient period (before hospital
discharge)
Medical issues related to the surgically treated knee 2 1
Withdrawal of consent by the patient 1 2
Other medical issues 2 1
Totals 5 4
Patients lost after hospital discharge (Weeks 2–52 after
surgery)
Medical issues related to the surgically treated knee 0 1
Withdrawal of consent by the patient 0 0
Other medical issues 1 1
Total losses 1 2
Table 2. Number of Patients Lost From Each Group and Reason for Loss
DISCUSSION support available through clinic-based

After primary total knee arthroplasty, rehabilitation was not advantageous for
patients who completed home-based the population studied. These findings
rehabilitation performed similarly to were not confounded by any interactions
patients who completed clinic-based with surgeon, type of prosthesis or time
rehabilitation during the first 4 weeks after since surgery. The current results extend
surgery. That all four criterion measures in those of previous studies of meniscectomy
the current study produced similar results 5,7,10 and anterior cruciate ligament
for the per protocol and the intent-to-treat reconstruction1,3,4,11 populations, and
analyses suggests that these findings apply corroborate a previous retrospective study
across a spectrum of disease-specific, using a total knee arthroplasty sample.
joint-specific, and functional variables. Patients who were lost to their assigned
Overall, the additional patient monitoring, group were not included in the per
adjustment of program, and motivational protocol analysis, but did raise concerns
that the group comparisons may have been Knee Society Knee Score
affected (Table 2). Comparisons within
80
and between groups indicated no 70
60
differences between patients lost and those 50
40 HOME
remaining. In addition, when patients who 30 CLINIC
20
had been lost to their assigned group, but 10
0
continued being tested at their normal PRE POST
follow-ups and had complete data sets,

Visual analog Score
were returned to their assigned group for
the intent to treat analysis, results were the 25
same as for the perr protocol analysis. For 20
these reasons, patient losses were not 15

HOME
considered to have significantly affected 10 CLINIC
the overall results of the current study. 5
0
PRE POST
Fig 2 A–C. Total scores for the
(A) Range of Motion Knee Flexion
Between discharge and 8 weeks,
weeks four
(B) ILOA level of assistance
(C) KSKS knee
nee society knee score more patients were removed from the
home-based group than from the clinic-
clinic
Range of Motion (Knee Flexion)
based group forr reasons related to failure
100 of the surgically treated knee to progress

80 (Table 2). These patients then had more
60
HOME intensive outpatient physical therapy than
40
CLINIC
that provided by the clinic-based
based program.
20
0 Four patients in the clinic-based

clinic group
PRE POST
were advised by their
eir surgeon to continue
ILOA Level of Assistance clinic-based rehabilitation after Week 12.

Although both groups of patients tended
35
30
to have poorer baseline scores on the
25 majority of objective measures, their
20 HOME
15 scores were not consistently low across
CLINIC
10
5 the same measures and tended to be
b within
0
1 standard deviation of the group mean.
PRE POST
The combination of poorer scores plus
subjective factors such as the patients’ enabled some monitoring of the patient’s
attitudes, motivation, pain tolerance, and medical status.
home environment were considered in The major component of the current study
making the decision to remove these was the common home exercise program,
patients from their assigned group or to taught to all patients during their
continue clinic-based rehabilitation. hospitalization after surgery and at their 8
Additional studies are needed to document week follow up. Outpatient clinicians used
psychosocial and demographic variables this program as the basis for their
to help identify patients who might derive treatments, and determined the number
greatest benefit from clinic-based and frequency of treatments, which
rehabilitation programs. averaged 15+-20 sessions; whereas the
The telephone calls to patients in the home home-based group was monitored by
based group were completed by an periodic telephone calls from a physical
experienced physical therapist who had therapist, which averaged 3+-1 calls
been introduced to all of the patients during the first 8 weeks after hospital
during their inpatient period. The discharge. At hospital discharge, patients
telephone calls focused on the home in the home-based group indicated when
exercises and did not introduce any new they wished to be telephoned, and again
exercises or provide unique treatment did so during each telephone call. Pilot
guidance beyond that available from study had indicated that virtually all
similarly experienced therapists. Two patients having primary total knee
patients with potential major arthroplasty had previous experience with
problem ,such as unresolved swelling, home exercise programs and that the
infection, and deep vein thrombosis, were majority preferred to determine the
identified via the telephone calls and were contact schedule themselves.
referred to the patient’s physician or In addition to the phone calls, the follow-
surgeon for treatment. Whether delayed ups at 4 and 8 weeks after surgery
treatment of these conditions would have included review of the home exercises.
resulted in major complications is unclear. That no patients in the home-based group
All of these patients completed the 8 week requested additional telephone calls after
study in their assigned group. As a result, 4weeks and only three patients in the
the telephone calls received by the home- clinic-based group phoned to ask
based group provided a form of minimally questions about the home exercises,
supervised rehabilitation, which also suggests all patients felt competent in
doing their home exercises. Although CONCLUSION
passive ROM was examined by the The current study compared two
surgeons at each follow up, active ROM rehabilitation programs, where the basic
was used to compare groups, to minimize component of each program was a series
the extent to which pain tolerance and of common exercises to be completed
motivation may have affected ROM. independently by all patients at home.
Compliance with the home exercises was Because these exercises were developed
considered high, with only two patients in by and taught to the patients by physical
the home-based group and one patient in therapists, the current study might be
the clinic-based group considered to have viewed as having compared two means of
been noncompliant at discharge and 4 providing physical therapy services; that is,
after surgery (where compliance was physical therapy monitored by telephone
defined as completion of the home calls (home-based) and physical therapy
exercises at least 90% of the time, as per monitored in person by outpatient physical
exercise log booklets). Exercise therapists (clinic-based). The current study
compliance was discussed with the did not compare physical therapy versus
patients before surgery and at each follow no physical therapy. There is no
up thereafter. The sample studied was significant difference in the data of study
limited to elderly patients who agreed to but there is statistical difference in both
be assigned randomly to one of the two group. So this pilot studies shows that the
rehabilitation programs. Approximately group of clinic based rehabilitation after
10% of eligible patients refused to total knee arthroplasty having more better
participate for this reason. The extent to prognosis than home based exercise group
which a home exercise program would be ie. range of motion and functional ability
effective for patients with a more and pain.
complicated history, more limited ROM,
or less motivation, needs to be determined.
REFERENCES:
1. Beard DJ, Dodd CAF: Home or controlled trial. J Orthop Sports
supervised rehabilitation following Phys Ther 27:134–143, 1998.
anterior cruciate ligament
reconstruction: A randomized 2. 2Bellamy N, Buchanan WW,
Goldsmith CH, Campbell J, Stitt
LW: Validation study of WOMAC:

A health status instrument for 7. Jokl P, Stull PA, Lynch JK,
measuring clinically important Vaughan V: Independent home
patient relevant outcomes to exercise versus supervised
antirheumatic drug therapy in rehabilitation following
patients with osteoarthritis of hip arthroscopic knee surgery: A
or knee. J Rheumatol 15:1833– prospective randomized trial.
1840, 1988. Arthroscopy 5:298–305, 1989.
3. De Carlo MS, Sell KE: The effects 8. Mahomed NN, Koo See Lin MJ,
of the number and frequency of Levesque L, Lan S, Bogoch ER:
physical therapy treatments on Determinants and outcomes of
selected outcomes of treatment in inpatient versus home-based
patients with anterior cruciate rehabilitation following elective
ligament reconstruction. J Orthop hip and knee replacement. J
Sports Phys Ther 26:332–339, Rheumatol 27:1753–1758,2000.
1997.
9. Rene J, Weinberge M, Mazzuca
4. Fischer DA, Tewes DP, Boyd JL, SA, Brandt KD, Katz BP:
et al: Home based rehabilitation Reduction of joint pain in patients
for anterior cruciate ligament with knee osteoarthritis who have
reconstruction. Clin Orthop received monthly telephone calls
347:194–199, 1998. from lay personnel and whose
medical treatment regimens have
5. Forster DP, Frost CEB: Cost- remained stable. Arthritis Rheum
effectiveness of outpatient 35:511–515, 1992.
physiotherapy after medial
menisectomy. BMJ 284:485–487, 10. Seymour N: The effectiveness of
1982. physiotherapy after medial
menisectomy. Br J Surg 56:518–
6. Insall JN, Dorr L, Scott RD, Scott 520, 1969.
WN: Rationale of the Knee
Society clinical rating system. Clin 11. Treacy SH, Baron OA, Brunet ME,
Orthop 248:13–14, 1989. Barrack RL: Assessing the need
for extensive supervised 12. Ware JE, Sherbourne CD: The
rehabilitation following Medical Outcomes Study Short
arthroscopic reconstruction. Am J Form (SF-36). Med Care 3:473,
Orthop 26:25–29, 1997. 1992. Clinical Orthopaedics 234
Kramer et al and Related Research
ACKNOWLEDGMENT:
The authors thank Dharam Pandey (MPT-neuro), Deepa Dabas (MSc-psycho) for assistance
throughout the study.
CORRESPONDENCE:
*Bijender Sindhu PhD,PT Research Student**Dr.Manoj Sharma, MBBS, MS(ortho)***Dr.Raj k Biraynia,
MBBS, D.ortho *School of Physical Therapy, Faculty of Medical Science, Singhania University**Department
of orthopedic surgery, Jaipur Golden Hospital *** Department of orthopedic surgery, Sarvodaya
Multispeciality Hospital. This study was not funded through a grant from the any organization.
Electrical Muscle Stimulation (EMS) Improve Functional Independence in

Critically Ill Patients
Dharam Pani Pandey PT*, Dr. Uday Shankar Sharma**,Dr. Ram Babu***
Abstract: Objective. This study was designed to investigate the effects of

electrical muscle stimulation (EMS) on strength of muscle groups stimulated and
improvement in functional independence in critically ill patients .Methods. 134
subjects were recruited among the patient admitted in multidisciplinary intensive
care units and randomly divided in to control and EMS group. Patients unable to
understand or speak English and or Hindi due to language barrier or cognitive
impairment prior to admission, unable to transfer from bed to chair at baseline
prior to hospital admission, Patient with known history of primary systemic
neuromuscular disease were excluded from study. Results. EMS group patients
achieved higher MRC scores than controls in knee extensors and ankle
dorsiflexors. Independence level was higher in EMS group Conclusions. EMS
application constitutes a promising means of muscle strength preservation and
early mobilization which can directly reflects the gain in functional independence
post ICU discharge in critically ill patients.
Key words: Electrical muscle stimulation, muscle strength, CIPNM, CIM,

functional independence
INTRODUCTION
Weakness that is acquired during critically ill patients1–3 and are associated
hospitalization for critical illness is with increased morbidity and mortality.4,5
increasingly recognized as common and Critical illness polyneuromyopathy
important clinical problem. Weakness (CIPNM) is an acquired neuromuscular
acquired in the intensive care unit (ICU) disorder observed in survivors of acute
and related acquired neuromuscular critical illness. It is characterized by
dysfunction occur in a large percentage of profound muscle weakness and
diminished or absent deep tendon The objective of this study is to
reflexes1 and is associated with delayed investigate whether electrical muscle
weaning from mechanical ventilation2 stimulation (EMS) will improve
suggesting a possible relation between functional independence in critically ill
limb and respiratory neuromuscular patients.
involvement. In addition, the syndrome is
associated with prolonged hospitalization
and increased mortality.3 The diagnosis of
CIPNM requires a reliable
eliable bedside muscle
strength examination and depends on
patient's cooperation and maximal effort.4
Several risk factors have been identified
including systemic inflammatory response
and sepsis5, medications such as
corticosteroids6 and neuromuscular
7
blocking agents , inadequate glycemic
control8, protracted immobility4,
hypoalbuminemia9, Gram--negative Our experimental Hypothesis was that
bacteremia9 and severity of organ “EMS would beneficially affect muscle
dysfunction.10 Thus, looking for the functional status and will improve
potentially reversible risk factors and functional independence in critically ill
subsequent adjustment of therapy are so patients.
far advocated as preventive measures to

decrease the risk of CIPNM. MATERIAL AND METHODS
A very few of studies available suggesting Subjects:

The 134 subjects were recruited among
the treatment and prevention of critical
the patient admitted inn multidisciplinary
illness myopathy these includes intensive
intensive care units during the study
insulin therapy, optimal gycemic control
period.
and minimized use of neuromuscular
uromuscular
blocking agents, high dose and prolong Exclusion criteria:
Unable to understand or speak English
use of corticosteroids.
and or Hindi due to language barrier or
cognitive impairment prior to admission,
OBJECTIVE OF THE STUDY
unable to independently transfer from bed
to chair at baseline prior to hospital EMS was implemented on knee extensors,

admission (based on detail history taken tibialis anterior and of both lower
from caregivers. Patient with known extremities. Patients received daily
history of primary systemic sessions. After skin cleaning, rectangular
neuromuscular disease, vascular events, electrodes (90 × 50 mm) were placed on
organ transplant, intracranial process that motor point of targeted muscle. The
is associated with localizing weakness, stimulator (Unistim, HMS medical system)
transferred from another ICU after >2 delivered biphasic, symmetric impulses of
consecutive days of mechanical 50 Hz, 100 µsec pulse duration, 12
ventilation, amputation of lower seconds at intensities able to cause visible
extremities, any limitation of life support, contractions. The duration of the session
pregnancy, age under 18 years, obesity, was 30 minutes each muscle group. EMS
technical obstacles that did not allow the sessions were continued until ICU
implementation of EMS such as bone discharge, both group were getting routine
fractures, skin lesions and, end-stage physiotherapy included the passive
malignancy were excluded from our study movements, active assisted movements
Design of study: and chest physiotherapy.
The study employed a randomized single Outcome Measures:
blind controlled experimental study design Primary Outcome Measures were the
consisting of two group experimental score of barthel index, it is reliable and
group and control group, Subjects were valid outcome measure used to assess
randomly assigned ether to experimental functional independence.
group or to control group everyday the Secondary Outcome Measures were lower
ICU patient admission register were extremity strength, at ICU discharge, of 2
observed and with in 24 hour the bilateral muscle groups which were
assessment were done , each time when a stimulated measured by MMT using a
patient met the criteria for inclusion a composite Medical Research Council
random number were picked up between 1 (MRC) score.
to 10 using sealed envelope method if it
were an odd number than the subject were DATA ANALYSIS AND RESULTS
assigned to experimental group similarly All continuous variables were presented
if it even number were obtained the by mean. The statistical significance of P
subjects were assigned to control group. value was set at 0.05. One-way repeated
Intervention: measures analysis of variance (ANOVA)
was made to compare MRC Grading and
barthel index score between-group.
group. Two
hundred and thirty-eight
eight patients were
admitted to our multidisciplinary ICU
during the eight-month
month study period and
104 patients fulfilled the exclusion criteria
or stayed in the ICU less than 48 hours.
The study population consisted of 134 Graph 1: Showing the mean and
significance level of two group of left and
patients of which of these
hese patients, 70 right knee extensor.
were randomly assigned to the EMS group
and 64 to the control group. 6 patients
from EMS group and 1 patient from
control died or were discharged from the
ICU before the second measurement.
MRC muscle grading score of muscle
group being stimulated were for left knee
extensors were control group mean 3.49
and EMS group mean 3.91 (p = 0.0187), Graph 2: Showing the mean and
significance level of two group of left and
right knee extensors control group mean
right ankle dorsiflexors.
3.69 and EMS group mean 3.87 (p =
0.0387). left ankle dorsiflexors control
group mean 3.78 and EMS group mean
m
3.91 (p = 0.04), right ankle dorsiflexors
were observed as follows mean control
group mean 3.37 and EMS group mean
3.3.46 (p = 0.0587) found.
Barthel index score of control group was
Graph 3: Showing the mean and
(mean) 68.6 and EMS group (mean) 71.9 significance level functional independence
and found significant between
een groups (p = level as assessed on barthel index.
0.010).
DISCUSSION
The main finding of our randomized
controlled study is that EMS of lower
extremities seems to preserve the muscle
strength of critically ill patients as specific health status.18 Recently, an study

assessed with MRC muscle strength identified an acute systemic effect exerted
grading system. EMS of lower extremities by EMS on peripheral microcirculation of
applied to critically ill patients upon critically ill patients.19 Specifically, after
admission is associated with a lesser performing a 45-minute session of EMS
degree of muscle strength loss of these on the lower extremities, an improvement
patients as assessed with MRC muscle in the microcirculation of the thenar
strength grading system. barthel index muscle as assessed by near infrared
score were higher in EMS group and the spectroscopy technique was observed.
patient of EMS group were more EMS, as a possible substitute to aerobic
independent. and resistance exercise training in severe
Electrical stimulation has been used to CHF and COPD patients, has been shown
increase strength and endurance in to improve muscle performance, aerobic
partially and fully paralyzed muscle. It has exercise capacity, and disease-specific
been used for peroneal nerve stimulation10, health status.9-11
11
the restoration of shoulder movement12,
recovery of tendonesis grip13, and in the CONCLUSIONS
use of an upper arm prosthesis.14 EMS exercise induces beneficial effects in
Electrical muscle stimulation (EMS) has muscle strength of ICU patients. These
been used as an alternative to active effects mainly concern muscle groups
exercise in patients with chronic heart directly stimulated, but there is also
failure (CHF)15 and chronic obstructive evidence of effects in muscle groups not
pulmonary disease (COPD).16, 17 Many of stimulated. EMS application constitutes a
these patients, even those who are promising means of muscle strength
clinically unstable, experience severe preservation and early mobilization which
dyspnea on exertion, which can prohibit can directly reflects the gain in functional
the regular application of conventional independence post ICU discharge in
exercise training, considered necessary for critically ill patients.
an integrated therapeutic approach. In a Clinical relevance & limitation
recent systematic review, EMS EMS is an alternative method of exercise
implementation in most of the selected causing minimal discomfort to patients
controlled clinical trials produced who are not able to perform any form of
significant improvements in muscle physical exercise, as is often the case in
strength, exercise capacity and disease- critically ill patients. It is a limitation of
this study that it did not evaluated the discharge with longer follow up
follow up stage and upper extremities evaluation, the muscle properties and
function. Further studies are needed to preventing CIPNM in critically ill patients
explore the possible role of EMS as a tool and to define which patients would benefit
for preserving the muscle strength and most from this intervention.
gain in functional independence post ICU
REFERENCES:
1. De Jonghe B, Sharshar T, 4. Garnacho-Montero J, Madrazo-
Lefaucheur JP, Authier FJ, Osuna J, Garcia-Garmendia JL,
Durand-Zaleski I, Boussarsar M, et Ortiz- Leyba C, Jimenez-Jimenez
al; Groupe de Reflexion et d’Etude FJ, Barrero-Almodovar A, et al.
des Neuromyopathies en Critical illness polyneuropathy:
Reanimation. Paresis acquired in risk factors and clinical
the intensive care unit: a consequences: a cohort study in
prospective multicenter study. septic patients. Intensive Care Med
JAMA 2002;288(22):2859–2867. 2001;27(8): 1288–1296.
2. De Letter MA, Schmitz PI, Visser 5. Spitzer AR, Giancarlo T, Maher L,

LH, Verheul FA, Schellens RL, Awerbuch G, Bowles A.
Op de Coul DA, van der Meche Neuromuscular causes of
FG. Risk factors for the prolonged ventilator dependency.
development of polyneuropathy Muscle Nerve 1992;15(6):682–686.
and myopathy in critically ill
patients. Crit Care Med 6. Rudis MI, Guslits BJ, Peterson EL,
2001;29(12):2281–2286. Hathaway SJ, Angus E, Beis S,
3. Coakley JH, Nagendran K, Zarowitz BJ. Economic impact of
Yarwood GD, Honavar M, Hinds prolonged motor weakness
CJ. Patterns of neurophysiological complicating neuromuscular
abnormality in prolonged critical blockade in the intensive care unit.
illness. Intensive Care Med Crit Care Med 1996;24(10):1749–
1998;24(8):801–807. 1756.
7. Latronico N, Peli E, Botteri M. Anesthesiology 2004;101(3):583–

Critical illness myopathy and 590.
neuropathy. Curr Opin Crit Care
2005;11(2):126–132. 12. MacFarlane IA, Rosenthal FD.
Severe myopathy after status
8. Bednarik J, Lukas Z, Vondracek P. asthmaticus (letter). Lancet
Critical illness polyneuromyopathy: 1977;2(8038):615.
the electrophysiological
components of a complex entity. 13. Witt NJ, Zochodne DW, Bolton
Intensive Care Med CF, Grand’Maison F, Wells G,
2003;29(9):1505–1514. Young GB, Sibbald WJ. Peripheral
nerve function in sepsis and
9. Van den Berghe G, Wouters P, multiple organ failure. Chest
Weekers F, Verwaest C, 1991;99(1):176–184.
Bruyninckx F, Schetz M, et al.
Intensive insulin therapy in the 14. Knox AJ, Mascie-Taylor BH,
critically ill patients. N Engl J Med Muers MF. Acute hydrocortisone
2001;345(19):1359–1367. myopathy in acute severe asthma.
Thorax 1986;41(5):411–412.
10. Tennila A, Salmi T, Pettila V,
Roine RO, Varpula T, Takkunen O.
15. Hund E, Genzwurker H, Bohrer H,
Early signs of critical illness
Jakob H, Thiele R, Hacke W.
polyneuropathy in ICU patients
Predominant involvement of motor
with systemic inflammatory
fibres in patients with critical
response syndrome or sepsis.
illness polyneuropathy. Br J
Intensive Care Med
Anaesth 1997;78(3):274–278.
2000;26(9):1360–1363.
16. Thiele RI, Jakob H, Hund E,

11. Rabuel C, Renaud E, Brealey D,
Tantzky S, Keller S, Kamler M, et
Ratajczak P, Damy T, Alves A, et
al. Sepsis and catecholamine
al. Human septic myopathy:
support are the major risk factors
induction of cyclooxygenase,
for critical illness polyneuropathy
heme oxygenase and activation of
after open heart surgery. Thorac
the ubiquitin proteolytic pathway.
Cardiovasc Surg 2000;48(3):145– in septic patients. Crit Care Med
150. 2005;33(2):349–354.
17. Garnacho-MonteroJ, Amaya-Villar
R, Garcia-Garmendia JL,Madrazo- 18. Bolton CF. Sepsis and the
Osuna J, Ortiz-Leyba C. Effect of systemic inflammatory response
critical illness polyneuropathy on syndrome: neuromuscular
the withdrawal from mechanical manifestations. Crit Care Med
ventilation and the length of stay 1996;24(8): 1408–1416.
ACKNOWLEDGMENT:
We would like also to acknowledge the support of all intensive care unit staff, consultants
and all the patients caregivers.
CORRESPONDENCE:
*Department Of Physiotherapy & Rehabilitation,BLK Super Speciality Hospital, Pusa Road, New Delhi, India.
**Sr. Consultant Neurologist, Department of Neurology, Jaipur Golden Hospital,2 institutional area, sector 3,
Rohini, New Delhi, India. ***Sr. Consultant Physician, Department of Internal, Medicine, Jaipur Golden
Hospital,2 institutional area, sector 3, Rohini, New Delhi, India.
A Comparative Study on Supervised Clinical Exercise versus Home Based

Exercise in Primary Unilateral Total Knee Arthroplasty
Bijender Sindhu PhD, PT*, Dr.Manoj Sharma, MBBS, MS(Ortho)**, Dr.Raj K Biraynia, MBBS,
D.Ortho***
Abstract: Objective. This study was designed to investigate the effects of

supervised clinical exercise and home Based Exercise in patient with unilateral
total knee arthroplasty in sub acute phase (after 5-6 weeks of discharge). To
assess the effect on function ability of patient after primary unilateral total knee
arthroplasty. To assess the effect on knee integrity (it include pain, ROM, knee
stability)of patient after primary unilateral total knee arthroplasty. Methods. 130
subjects were recruited from OPD physiotherapy among the patient discharge
from hospital and randomly divided into supervised clinic exercise and home
based exercise. Socio demographic and clinical data, pain, range of movement
(ROM) and function of TKA patients were collected on day of discharge (ie day 5
to 8 post operation). A self designed data capture sheet, the goniometer, VAS
(Visual Analogue Scale) and ILOA (Iowa Level of Assistance) KSKS (kne society
knee score)were used to measure data. Criteria for recruitment is patient having
primary unilateral total knee replacement, having a functional hip on operated
side, both male and female and age between 50 to 80 years. Able to follow simple
verbal commands. Patient excluded from study who are suffering from
Rheumatoid Arthritis, revision TKA, bilateral knee arthroplasty. Results. The
results indicate that there is significant difference between experimental group
(supervised clinical exercise) and Control group (home based exercise). For knee
integrity measured using the Knee Society Knee Score (p=0.017)and function
measured using the ILOA Scale (p= 0.018) and goniometry (p=>0.05). The
average age was 64 years in male and 66 years in females . There were 41%
males and 59% females. There is statistical difference between pain, range of
motion, Knee integrity, Knee functional outcomes of groups that receive post-
discharge outpatient physiotherapy as compared to those who do not attend
physiotherapy. Conclusions. After primary total knee arthroplasty, patients who
completed a home based exercise program (control group) performed similarly to
patients who completed regular outpatient clinic sessions in addition to the home
exercises (supervised clinic exercise ie. experimental group). Additional studies
need to determine which patients are likely to benefit most from clinic-based
rehabilitation programs. The overall aim of this study was to establish the early
post operative status of Total knee arthroplasty patient.
Key words: Supervised clinical exercise, Home based exercise, KSKS (knee
society knee score), ILOA (ILOA level of assistance)
INTRODUCTION
Osteoarthritis is a leading cause of pain aims to minimize the complications
and disability affecting joints (Marchet al following total knee replacements and to
1999). Progressive loss of the articular rehabilitate the patient to full functional
cartilage can result in joints that are recovery. Techniques such as cryotherapy,
painful and inflamed. The joint becomes strengthening and stretching exercises are
stiffer and there is less stability in the joint used (Zavadak et al 1995). Physiotherapy
(Parmet et al 2003). These factors affect in hospital also includes functional
the function of the joint which ultimately techniques such as bed mobility, transfers,
impacts on patients’ functional ability and ambulation and stair climbing. An
their quality of life (March et al 1999). assumption can be made that if there is a
Total knee arthroplasty has been found to relationship between knee integrity and
be effective in the management of pain function, physiotherapists may decide to
(Palmer & Cross, 2004), functional status only work on improving function, or only
and quality of life in people suffering from work on improving knee integrity
OA, rheumatoid arthritis (RA) and related (improving knee range of motion,
conditions (Zavadak et al., 1995). reducing swelling, reducing pain and
Physiotherapists aim to prevent improving muscle strength). Time could
contractures (Lenssen et al., 2006) then be better utilized on one aspect of
decrease pain and swelling and improve rehabilitation.
knee and functional mobility in Early discharge can sometimes result in
preparation for discharge (Oldmeadow et transfer to an inpatient facility. A study by
al.,2002. Post operative physiotherapy Bozic et al. (2006), states that clinical,
demographic and socioeconomic factors operation who gave informed

all affect the decision to discharge a constant).Able to follow simple verbal
patient to an inpatient rehabilitation centre. commands
Objective of the Study:
To assess the effect on knee integrity (it Exclusion criteria:
include pain, ROM and knee stability) and Any additional trauma to the lower limb,
knee function ability. To establish inability to participate in the assessment
pain,ROM of the operated knee and from a physical and cognitive point of
functional level of TKA patients. To view such as dementia, confusion etc.
establish socio-demographic factors and Inability of the patient to walk prior to the
clinical data of TKA patients on first TKA(with or without aid). Patient
follow up. To establish the relationship suffering from Rheumatoid Arthritis.
amongst supervised clinical exercise as Unwillingness to participate in the
well as home based exercise and assessments Revision TKA, Bilateral knee
postoperative functional status of TKA arthroplasty. Inability of the patients to
patients. To study this procedure can be walk prior to the total knee replacement
clinically implemented. (with or without the aid of an assistive
device).
MATERIAL AND METHODS
Subjects: 130 subjects were recruited Design of study:
from OPD physiotherapy among the The study employed a randomized single
patient discharge from hospital and blind controlled experimental study design
randomly divided into supervised clinic consisting of two group experimental
exercise and home based exercise. group and control group, Subjects were
randomly assigned either to experimental
Inclusion criteria: group or to control group everyday in
Patient having primary unilateral total physiotherapy OPD before discharge ,
knee replacement having a functional hip each time when a patient met the criteria
on operated side .Both male and female for inclusion a random number were
who had a primary unilateral TKA able to picked up between 1 to 10 using sealed
give independent informed consent Patient envelope method if it were an odd number
between the age of 50 to 80 years of age, than the subject were assigned to
presented to the first follow-up session. experimental group.
(This was around six to eight weeks post
Intervention assistive devices and appliance, walking
Supervised clinical exercise: These are pattern, safety & precaution, do’s and
exercise which are perfomed by patient dont’s.
under the observation of a qualified
physiotherapist. Postoperative Outcome Measures:
rehabilitation usually consists of passive ILOA : The patients’ functional ability
and active knee mobilisation, quadriceps was assessed using the Iowa Level of
strengthening and functional activities Assistance (ILOA) Scale, which was first
(Lenssen et al., 2006). Hip and knee described by Shields et al (1995). It was
flexion; hip and knee extension in neutral; shown to be reliable and valid.The best
hip abduction; hip adduction to neutral; overall result the patient is able to achieve
ankle dorsi- and plantar flexion, static with this scale is zero. This indicates that
quadriceps contraction and inner range the patient was able to perform all five
quadriceps contraction over a rolled up tasks independently without the use of any
towel. The physiotherapist performs anti- assistive device. The worst overall score
inflammatory modalities on the patient that could be achieved is fifty which
which include ultrasound, interferential indicates that the patient was unable to
therapy, pulsed short wave diathermy, perform the tasks due to medical and
transcutaneous electrical nerve stimulation safety reasons and the assistive device
(TENS), laser, acutouch and heat or used for standing or mobilizing was a
cryotherapy. Myofascial release, walking frame.
continuous passive mobilisation exercises, KSKS: This rating system was developed
stretching, strengthening exercises, gait in 1989 by the American Knee Society to
re-training, massage, patient education provide an evaluation form for knee
and an exercise programme are also integrity (Insall et al, 1989). The knee
prescribed. assessment has three parameters which
Home based exercise: Home based measure pain, stability and range of
exercise group performed the exercise motion. The knee is given a score out of a
which are explained and demonstrated by hundred. A well-aligned knee with no pain,
physiotherapist in OPD at the time of negligible instability and range of motion
discharge to the patient for home, which of 125 degrees scores a hundred points
included isometric exercises for Goniometry: It is a measuring tool used to
quadriceps, knee range of motion, assess the range of motion of a joint. It
strengthening exercise, effective use of can be used as an initial assessment and it
evaluate the patient’s progress (Rothstein TKA patients, Knee integrity and Socio-
et al 1983). Rothstein et al (1983) assessed demographic factors and clinical data of
goniometric reliability and which TKA patients, The relationship between
goniometer size was the most reliable in a identified factors and postoperative
clinical setting. functional status of TKA patients in
relevance of level of assistance (ILOA) in
DATA ANALYSIS AND RESULTS control group mean (home based exercise)
All continuous variables were presented is11.94 and experimental group
by mean. The statistical significance of P (supervised clinical exercise) 10.01 (p=
value was set at 0.05. 0.018), KSKS in control group mean
One-way repeated measures analysis of (home based exercise) is74.72 and
variance (ANOVA) was made to compare experimental group (supervised clinical
ILOA score, KSKS score, Goniometry exercise) 76.78 (p=0.017), goniometry in
range between-groups. control group mean (home based exercise)
130 subjects were recruited from OPD is 88.06 and experimental group
physiotherapy among the patient (supervised clinical exercise) 95.52
discharge from hospital and randomly (p=>0.05) found.
divided into supervised clinic exercise and
ROM Knee Flexion
home based exercise. 19 patients not 150.
ROM )in degtree)
100.
fulfilled the inclusion criteria and four
50.
patients due to prolonged hospital stay for
0.
medical reasons, two patients for medical pre post
Home 30.46 88.06
conditions, two patient consented to the
Super 28.86 95.52
socio demographic and clinical
questionnaire, but not to the goniometry
significance level of range of motion of
and Iowa Level of Assistance (ILOA) two group of supervised and home based
exercise.
testing, and therefore had to be excluded.
One patient refused to be tested · two
40. ILOA
patient had been discharged before the 30.
researcher had been able to collect data 20.
Level of assistence
10.
(morning of day three). 0.
pre post
The following results are presented:
Home 33.9 11.94
Range of movement (ROM) of the
Super 32.9 10.1
operated knee and functional level of
Graph 2: Showing the mean and been shown to reduce pain in patients at
significance level of IOLA(level of
intervals of 24-hours, 48-hours, 72- hours
assistance) of two group of supervised and
home based exercise. and at one to eight weeks post operation
(Hubbard and Denegar 2004; Jensen et al
100. KSKS 1985; Jarit et al 2003).
Knee integrity &
2: Range of motion: People normally

function
50.
require knee flexion of 45º to 105º during
0.
pre post various activities of daily living. To
Home 18.16 74.72
demonstrate a normal gait pattern, 65º of
Super 18.52 76.78
flexion is required. To ascend and descend
stairs, 90º of flexion is needed and to go
significance level of KSKS (knee society
knee score) of two group of supervised from sitting to standing, 105º of flexion is
and home based exercise.
required (Miner et al 2003). From the
results of the range of movement shows
DISCUSSION
that experimental group (mean=95.52) and
KSKS: 1. Pain: Fifty percent of the
control group (mean=88.06), one can
patients had virtually no pain at six weeks
assume that 51% of the patients (twenty
post operation. The other fifty percent had
six patients) would not be able to go from
pain that ranged from occasional to severe
sitting to standing as they only had knee
pain Two patients (4%) had severe pain.
flexion of 80º. However, from our sample
This indicates that the patients’ pain is not
of 50-patients, 24-patients (49%) who had
being managed well at home after
90º-100 of knee flexion were able to go
discharge. They are perhaps not given
from sitting to standing independently
physiotherapy modalities which are
without any assistance or assistive devices.
healing in reducing pain. Cryotherapy and
Patients with less than 95º of knee flexion
simultaneous exercise is more effective in
had worse Goniometry scores (p<.0001).
reducing pain than icing alone. Icing and
Only patients with a very stiff knee will
compression also helps to reduce pain in
have function that is really affected by
patients post surgery. Transcutaneous
ROM. Their study identified 95º of knee
Electrical Nerve Stimulation (TENS)
flexion as a clinically meaningful cut-off
causes a reduction of pain in 93% of
point above which ROM does not limit a
patients who undergo surgery and the
patient’s normal activities after TKR.
TENS group of patients consumed less
However the long-term effects of this
pain medication. Interferential therapy has
limitation of ROM could be detrimental to
the normal joints, because of the patients this range of motion, the patient should
over compensation when performing manage functionally. Patients also
activities of daily living. compensate when performing activities by
3. Knee Stability and alignment: The using the other leg or their arms to assist
majority of the patients had normal with transfers. The quality of the
stability and alignment. This indicates that movement being performed is not
the total score of the Knee Society Knee important to the patient, what is of
Score in this sample is not really affected importance is completing the movement
by the components of stability and by any means possible. The long term
alignment, but mainly by pain and ROM. effect of poor ROM and poor quality of
Malalignment of the prosthesis could movement is that the normal joints take
result in stiffness which although excess strain and over a prolonged period,
uncommon is a disabling problem (Jerosh there is an increased risk of developing
and Aldawoudy 2007). Treatment of pain and discomfort in the normal joints
malalignment could include manipulation due to osteoarthritis.
or revision arthroplasty (Bong and Di ILOA Score:
Cesare 2004),which has been shown to be Most of the patients were able to go from
successful in terms of post-operative lying to sitting, sitting to standing and
function(Miner et al 2003). walking 4.57 meters independently, with
4. Knee Flexion contracture and extension minimal assistance. The patients scored
lag: A percentage of the patients in this very well in these three categories. This
study had some degree of a flexion indicates that the ILOA Scale is not a
contracture and some degree of an sensitive enough functional measuring
extension lag at six weeks post operation. tool when used at six weeks post operation.
This could indicate that attaining full knee It measures basic functional ability, not
extension and flexion is not that important higher function. It was developed to
when it comes to functional activities such determine whether patients who had had
as going from sitting to standing, walking total hip and knee replacements were
and stair climbing, as these same patients ready to be discharged from hospital
performed well when assessed using the (Shield et al 1995). It is the role of
ILOA Scale. Functional range of motion is physiotherapists in the hospital to ensure
between 45º and 105º (Miner et al 2003). that patients are able to perform basic
As long as the extension lag and the transfers so that they will be independent
flexion contracture do not interfere with at home, after they are discharged from
hospital. Five patient did not use an therapist with knowledge of their acute
assistive device to perform the five postoperative status and appropriate
functional tasks. She did however require rehabilitation programme that will
nearby supervision for the walking, stairs influence their prognosis. integrity which
and the speed test. Two patients used a was measured using the Knee Society
walking frame at six weeks after the Knee Score and function as measured
operation. Only one patient was unable to using the ILOA Scale, six to eight weeks
climb the stairs even with maximal post surgery on total knee replacement.
assistance Research Recommendations:
A functional tool should be developed that
CONCLUSIONS assesses the attainment of higher
The goal of a TKA is to provide the functional milestones, as well as the
patient with a stable and painless knee quality of the movement. If a more
with sufficient ROM to perform ADL’s sensitive functional assessment tool was
(Gandhi et al., 2006). As many studies used, one that looked at higher functional
only focused on the long-term status of levels, a more accurate functional
TKA patients (Aarons et al., 1996), this evaluation of the knee replacement could
study examined the short-term status. The be determined.
value of this is to furnish patients and the
REFERENCES:
1. De Jonghe B, Sharshar T, polyneuropathy and myopathy in
Lefaucheur JP, Authier FJ, Durand- critically ill patients. Crit Care Med
Zaleski I, Boussarsar M, et al; Groupe 2001;29(12):2281–2286.
de Reflexion et d’Etude des
Neuromyopathies en Reanimation. 3. Coakley JH, Nagendran K,
Paresis acquired in the intensive care Yarwood GD, Honavar M, Hinds CJ.
unit: a prospective multicenter study. Patterns of neurophysiological
JAMA 2002;288(22):2859–2867. abnormality in prolonged critical
illness. Intensive Care Med
2. de Letter MA, Schmitz PI, Visser 1998;24(8):801–807.
LH, Verheul FA, Schellens RL, Op de
Coul DA, van der Meche FG. Risk 4. Garnacho-Montero J, Madrazo-
factors for the development of Osuna J, Garcia-Garmendia JL, Ortiz-
Leyba C, Jimenez-Jimenez FJ, 9. Van den Berghe G, Wouters P,

Barrero-Almodovar A, et al. Critical Weekers F, Verwaest C, Bruyninckx F,
illness polyneuropathy: risk factors Schetz M, et al. Intensive insulin
and clinical consequences: a cohort therapy in the critically ill patients. N
study in septic patients. Intensive Care Engl J Med 2001;345(19):1359–1367.
Med 2001;27(8): 1288–1296.
10. Tennila A, Salmi T, Pettila V,
5. Spitzer AR, Giancarlo T, Maher L, Roine RO, Varpula T, Takkunen O.
Awerbuch G, Bowles A. Early signs of critical illness
Neuromuscular causes of prolonged polyneuropathy in ICU patients with
ventilator dependency. Muscle Nerve systemic inflammatory response
1992;15(6):682–686. syndrome or sepsis. Intensive Care
Med 2000;26(9):1360–1363.
6. Rudis MI, Guslits BJ, Peterson EL,
Hathaway SJ, Angus E, Beis S, 11. Rabuel C, Renaud E, Brealey D,
Zarowitz BJ. Economic impact of Ratajczak P, Damy T, Alves A, et al.
prolonged motor weakness Human septic myopathy: induction of
complicating cyclooxygenase, heme oxygenase and
neuromuscular blockade in the activation of the ubiquitin proteolytic
intensive care unit. Crit Care Med pathway. Anesthesiology
1996;24(10):1749–1756. 2004;101(3):583–590.
7. Latronico N, Peli E, Botteri M. 12. MacFarlane IA, Rosenthal FD.

Critical illness myopathy and Severe myopathy after status
neuropathy. Curr Opin Crit Care asthmaticus (letter). Lancet
2005;11(2):126–132. 1977;2(8038):615.
8. Bednarik J, Lukas Z, Vondracek P. 13. Witt NJ, Zochodne DW, Bolton

Critical illness polyneuromyopathy: CF, Grand’Maison F, Wells G, Young
the electrophysiological components GB, Sibbald WJ. Peripheral nerve
of a complex entity. Intensive Care function in sepsis and multiple organ
Med 2003;29(9):1505–1514. failure. Chest 1991;99(1):176–184.
14. Knox AJ, Mascie-Taylor BH, 17. Garnacho-MonteroJ, Amaya-Villar
Muers MF. Acute hydrocortisone R, Garcia-Garmendia JL,Madrazo-
myopathy in acute severe asthma. Osuna J, Ortiz-Leyba C. Effect of
Thorax 1986;41(5):411–412. critical illness polyneuropathy on the
withdrawal from mechanical
15. Hund E, Genzwurker H, Bohrer H, ventilation and the length of stay in
Jakob H, Thiele R, Hacke W. septic patients. Crit Care Med
Predominant involvement of motor 2005;33(2):349–354.
fibres in patients with critical illness 18. Bolton CF. Sepsis and the
polyneuropathy. Br J Anaesth systemic inflammatory response
1997;78(3):274–278. syndrome: neuromuscular
manifestations. Crit Care Med
16. Thiele RI, Jakob H, Hund E, 1996;24(8): 1408–1416.
Tantzky S, Keller S, Kamler M, et al.
Sepsis and catecholamine support are 19. Latronico N, Fenzi F, Recupero D,
the major risk factors for critical Guarneri B, Tomelleri G, Tonin P, et
illness polyneuropathy after open heart al. Critical illness myopathy and
surgery. Thorac Cardiovasc Surg neuropathy. Lancet 1996;
2000;48(3):145–150. 347(9015):1579–1582.
ACKNOWLEDGMENT:
The authors thank Dharam Pandey (MPT-neuro), Deepa Dabas (MSc-psycho) for assistance
throughout the study.
CORRESPONDENCE:
*Bijender Sindhu PhD,PT Research Student**Dr.Manoj Sharma, MBBS, MS(ortho)***Dr.Raj k Biraynia,
MBBS, D.ortho *School of Physical Therapy, Faculty of Medical Science, Singhania University**Department
of orthopedic surgery, Jaipur Golden Hospital *** Department of orthopedic surgery, Sarvodaya
Multispeciality Hospital. This study was not funded through a grant from the any organization.
Comparison of the Effect of Isometric Exercise of Upper Limb on Vitals

between Young Males and Females
Pranjal Parmar. BPT*
Abstract: Background and objective: studies on gender difference in

cardiovascular responses to isometric exercises have been numerous and
confliction the objective of this study was to determine if cardiovascular response
to upper extremities isometric exercises differ between apparently healthy male
and female subjects. Method: 60 young adults age between 18 to 22 years were
included in study. These consisted of 30 males and 30 females. The baseline
cardiovascular parameters (HR, SBP, DBP & MAP) were recorded. After two
sets of three isometric upper limbs for 3 minutes these parameters recorded at the
end of exercise and after recovery. Results:An increase in HR ,SBP , DBP&MAP
was seen in both groups after exercise .the result showed group B had more
increase in HR,SBP,DBP and MAP as compared to group A and significant rise
in MAP &SBP in group B. Conclusion: Isometric exercise of upper limb can lead
to increase in SBP, DBP, MAP &HR among apparently healthy males & females.
It is more proannounced in males as compared to females. SBP &MAP increased
in both but more in males as compared to females.
Keywords: Isometric Exercises, Cardiovascular Measures
INTRODUCTION
Exercise, a common physiological stress, seen in various exercises like pushing or
can elicit cardiovascular abnormalities not lifting heavy load where net displacement
present at rest and can be used to of load is not, but the rising tension can be
determine the adequacy of cardiac felt in contracting muscles.3 It imposes
function.1 The isometric contractions are greater pressure than volume load on left
ventricle in relation to the body ability to During exercise it is mainly adrenaline
supply oxygen.4 The metabolic demands that produces changes in the heartbeat.
of the exercising muscles increases, Adrenaline is a hormone which causes the
depending upon intensity of exercises and heart rate to quicker.
are met with various changes in 2. Breathing quickens and deepens:
circulatory and respiratory system.13 You breathe quicker so as to get more
The effect of isometric exercises on vitals oxygen into the lungs. An efficient heart
in between males and females may vary can then transport this to the working
with substantial anatomical, physiological muscles. Training can be of great benefit
and morphological differences that exist to the Respiratory System. The capacity of
between men and women which may the lungs is increased, which allows more
affect their exercise capacity and influence oxygen to be taken in per breath.
magnitude of response to exercise.5 3. Temperature rises:
The average isometric strength estimate is When we exercise, our muscles are
generally 30% greater in men than in working and they generate heat, so our
women in different muscle group. Gender body temperature rises. Body temperature
difference in cardiovascular response to is regulated by heat radiating from the
static exercise is believed to be due to skin and water evaporating by sweating.
differences in sympathetic – When we shiver, our muscles are working
parasympathetic or adrenal interactions at to produce heat in order to raise our body
cardiac level. temperature.
The larger the muscle group that is 4. Start to sweat:
involved in isometric tension the greater As we have just seen, some of our energy
the cardiovascular response.6 is turned into heat. The body will tolerate
Response To Exercise:7 a small rise in temperature, but very soon
When you exercise or take part in a we begin to sweat. If the conditions are
strenuous sport you will notice several hot, we sweat more and produce less urine.
changes taking place in your body: We also lose salt as well as body heat and
a. Your heart beats stronger and faster water. We have to replace the salt so that
b. Your breathing quickens and deepens the body stays the same, otherwise we will
c. Your body temperature increases get cramp.
d. You start to sweat 5. Muscles begin to ache:
e. Your muscles begin to ache As we now know, in order to work,
1. Heart beats stronger and faster: muscles need energy. Energy comes from
food, which is mainly converted to Vitals response to exercise has been used
glucose. To work more efficiently muscles as major criteria in exercise prescription
also need plenty of oxygen. Glucose and for both patient and healthy population.
oxygen are brought to the muscles in the Thus for prescribing isometric exercise,
blood. Wastes such as carbon dioxide are repetitions and frequency it would be
carried away in the blood. This process of helpful and prevent the adverse effect on
getting energy is called respiration. vitals. The study would also be helpful in
Glucose + Oxygen = Energy + CO2 + prescribing exercises for those with
Water cardiovascular compromise. It would help
When muscles do extra work more to determine the safety limits of the
Glucose and Oxygen are needed, so more exercise.
blood must flow to the muscles.
Eventually it becomes impossible to get OBJECTIVES:
enough oxygen to the muscles, so they use 1. To analyze if there is any change in
a different method of getting energy. vitals as a result of isometric exercises of
Glucose is still used, but now there is a upper limb
waste product called lactic acid, which 2. To compare the response of upper limb
makes muscle ache, & muscles. isometric exercises in young male and
female.
Acute Cardiovascular Response to
Exercise: METHODOLOGY
As exercise intensity increases, heart rate, Research Design: An quasi-Experimental
stroke volume, and cardiac output increase (comparative) study. Sample Size: 60
to get more blood to the tissues. More normal individuals. Sample Population:
blood forced out of the heart during 60 young adults between 18 to 22 yrs.
exercise allows for more oxygen and Group A: 30 normal individuals (females)
nutrients to get to the muscles and for Group B: 30 normal individuals(males)
waste to be removed more quickly. Blood Type of Sampling: Convenient sampling
flow distribution changes from rest to with random assignment. Duration of
exercise as blood is redirected to the Study: one month. Study Set Up:
muscles and systems that need it. Physiotherapy OPD of a tertiary care
hospital.
CLINCAL SIGNIFICANCE Inclusion Criteria:
• No previous history of known intervention was explained to the
cardiovascular condition. individuals and their written consent was
• Normal values of vitals at rest. taken from them. 60 individuals were
• No neurological defecit in upper assigned into two groups, group A and
limb. group B, 30 patients in each group.
• Sex – both male and female. Procedure details of group A and group B:
• Willingnessof patient. Pre-measures: Heart rate and blood
Exclusion Criteria: pressure was measured using an electronic
• Fracture of upper limb bones. sphygmomanometer in standing position.

Reading was noted.
• Cervical vertebrae or scapula
Individual position: standing position.
fracture.
Therapist position: on the individual side
• Neurogenic deficit.
in stride standing position.
• Congenital anomalies.
Procedure: Participants in upstanding
• Previous exercise training
position performed 3 upper extremities
• Any disability limiting to upper
isometric exercises i.e. 2 sets of each
limb exercise.
exercise for each 30 second each thus total
• Psychiatric patients.
duration of exercise for 3 minutes.
• Non-willing patients.
1. The exercise are pushing against the
Outcome Measures:
wall with outstretched arms and were
• Heart rate of patient at rest,
instructed to exert maximal tension on
immediately post exercise and 3
wall.8
minutes after exercise
2. Hands clasped together and brought to
• Blood pressure i.e. systolic and
manubrosternal level to chest while
diastolic blood pressure at rest,
shoulders are 60 70 degree abducted and
immediately postexercise and 3
participants were instructed to maximally
minutes after exercise.
generate tension by pressing opposite
• Mean arterial pressure was
hands against each other.8
calculated from the above data.
3. Both palms on wall with participants
standing ahead arms extended and were
PROCEDURE
asked to push the wall without coming
60 individuals were selected according to
behind and keeping elbow straight.8
the inclusion and exclusion criteria. The
Participants were instructed to avoid
need of the study and treatment
valsalva maneuver by not holding breath
Thereafter participants were asked to rest

MEAN AGE OF POPULATION
for 10 minutes before leaving. Post-
20.25
measures: Heart rate and blood pressure 20.2
20.15 MEAN AGE
was measured immediately after exercise
20.1 OF
and 3 minutess after exercise. All patients POPULATION
were comfortable after the treatment
session.
The above graph shows mean age of
group A and group B.
DATA ANALYSIS AND RESULT
The data collected was entered in excel
sheet and statistical analysis was done Table 2
using SPSS software. Heart rate and blood Rest Post Recovery
exercise
pressure are objective data hence can be Group A 117.8 123.28 120.45
considered for statistical analysis. This (females)
Group B 123.6 134.58 128.95
isan interval data hence pre and post (males)
parmeters was statistically analysed using
paired t-test,
test, and difference in paramaters
paramate
Rest Post Recovery Table 3

exercise Value P value Significance
Value -5.46072 -10.1411
10.1411
-10.0176 Group -1.6912 3.47e-
3.47e Difference is
P 1.64e-05 3.14e-09
3.14e2.19e-11
value A 10 significant.
between two groups was statistically Group -1.3678 3.17e-
3.17e Difference is
analysed using unpaired t-- test. B 12 significant.
Table 4
Table No.1
Mean age (yrs)of
)of study group Table 2 shows mean of systolic blood
Group Number Age (yrs) pressure at rest in group A is 117.8 and
A 30 20.23
B 30 20.16 group B IS 123.6 ,post exercise in group
A is 123.28 and group B is 134.58 and
recovery in group A is 120.45and group B
is 128.95.
Table 3 shows p value by paired t test in 0.3SYSTOLIC BLOOD PRESSURE - RECOVERY
group A and group B and difference is 0.25
0.2
statically significant. 0.15 Female
Table 4 shows p value by unpaired t test in 0.1
Male
0.05
group A and group B at rest, post exercise
0
and recovery and difference is statically 108
110
112
114
116
118
120
122
124
126
128
128
130
132
significant.
The above graph shows distribution of

150 SYSTOLIC BLOOD PRESSURE systolic blood pressure in males and
100 females at rest, post exercise and recovery.

Diastolic Blood Pressure
50
Table 5
0 Rest Post Recovery
REST POST RECOVERY exercise
EXERCISE Group A 75.6 84.25 80.20
(Females)
The graph shows mean of males and Group B 80 96.50 83.60
females of systolic blood pressure at rest , (Males)
post exercise and recovery.
Table 6
Value P value Significance
.
Group -1.345 3.95e- Difference is
0.2 SYSTOLIC BLOOD PRESSURE - REST A 15 significant.
0.15 Group -1.236 3.21e- Difference is
0.1 Female B 08 significant.
0.05 Male Table 7
102106110114118122126130 exercise
Value -5.78263 -14.6703
14.6703 -4.4098
P 1.1e-06 3.14e-09 09 1.58e-07
value
0.15SYSTOLIC BLOOD PRESSURE - POST EXERCISE
0.1
Table 5 shows mean of diastolic blood
Female
0.05 pressure at rest in group A is 75.6 and
Male
0 group B is 80, at post exercise in group A
108112116120124128132136140
is 84.25 and in group B is 96.50 and at
recovery in group A is 80.20 and group B
is 83.60.
Table 6 shows p value by paired t test in The above graph shows distribution of
group A and group B and difference is diastollic blood pressure between males
statistically significant. and females at rest, post exercise and
Table 7 shows p value by unpaired t test at recovery.
rest, post exercise and recovery in group
A and group B and difference is Mean Arterial Pressure
statistically significant Table 8
Rest Post Recovery
exercise
Group A 89.66 97.26 93.61
DIASTOLIC BLOOD PRESSURE
(Females)
120 Group B 94.53 109.19 98.71
100
80 (Males)
60 FEMALES
40 Table 9
20
0 Value P value Significance
MALES A 10 significant
B 12 significant.
Table 10
The above graph shows mean of males
Rest Post Recovery
and females of diastolic blood pressure at exercise
rest, post exercise and recovery. Value -7.001 -9.57881 -7.17096
P value 1.16e- 1.91e-11 2.06e-09
09
0.2 DIASTOLIC BLOOD PRESSURE - REST Table 8 shows mean of mean arterial
0.1 Female pressure at rest in group A is 89.66 and in
0 Male group B is 94.53,at post exercise in group
68 70 72 74 76 78 80 82 84 86 88 A is 97.26and in group B is 109.19 and at
recovery in group A is 93.61 and group B
0.2 DIASTOLIC BLOOD PRESSURE - POST EXERCISE
is 98.71.
0.1 Female Table 9 shows p value by paired t test in
0 Male
group A and group B difference is
74767880828486889092949698100
102
statistically significant.
Table 10 shows p value by unpaired t test
0.2 DIASTOLIC BLOOD PRESSURE - RECOVERY
at rest, post exercise and recovery in
0.1 Female
0 group A and group and difference is
Male
70 72 74 76 78 80 82 84 86 88 90 92 statistically significant.
The above graph shows distribution of
mean arterial pressure between males and
MEAN ARTERIAL PRESSURE
females at rest, post exercise and recovery.
120
100
80
60 Heart Rate
40
20 FEMALES Table 11
MALES
exercise
Group A 72.6 80.40 76.40
(Females)
Group B 74.4 82.95 78.65
(Males)
Table 12
The above graph shows mean of mean Value P value Significance
arterial pressure at rest, post exercise and Group 0.00615 0.015E- Difference
A 04 is
recovery between group A and group B. significant
Group 0.00322 0.14E- Difference
B 05 is
0.2MEAN ARTERIAL PRESSURE -REST significant
0.15 Table 13
Rest Post Recovery
0.1 Female
exercise
0.05 Male Value 0.00123 0.00808 0.00055
0 P 0.012e- 0.080e- 0.055e-06
80 90 100 value 06 05
Table 11 shows mean of heart rate at rest

0.1 MEAN ARTERIAL PRESSURE - POST EXERCISE
in group A is 72.6 and in group B is 74.4,
0.05 Female at post exercise in group A is 80.40 and in
0 Male group B is 82.95 and at recovery in group
86889092949698
100
102
104
106
108
110
112
114
116
118 A is 76.40 and in group B is 78.65.
0.2 MEAN ARTERIAL PRESSURE - RECOVERY Table 12 shows p value by paired t test in
0.15
group A and group B and difference is
0.1 Female
0.05 Male
Table 13 shows p value by unpaired t test
0
82 84 86 88 90 92 94 96 98 100102104106 at rest, post exercise and recovery in
group A and group B and difference is
Heart Rate The above graph shows distribution of
100 heart rate between males and females at

80
60
rest, post exercise and recovery.
40
20
0 FEMALES
DISCUSSION
MALES
The study investigated the gender
difference in cardiovascular response to
The above graph shows mean of heart rate upper extremities isometric exercise
in males and females at rest, post exercise among apparently young healthy subjects.
and recovery. 60 participants were included in the study.
They were divided into two groups, group
0.2 HEART RATE - REST A and group B. Group A included female
0.15 gender and group B included male gender.
BP, HR and MAP were taken as outcome
0.1 Female
Male
measure. These measures were taken pior,
0.05
immediately after test and 3 minutes after
0
study. The data collected was statistically
65 70 75 80
analysed. The result showed group B had
more increase in HR,SBP ,DBP AND
0.15 HEART RATE - RECOVERY
MAP as compared to group A and there
0.1 was significant rise in MAP and SBP in
Female group B. The average isometric strength
0.05 Male estimate is generally about thirty percent
0 greater in men than in women in different
68 78 88 muscle groups . Upon initiating isometric
tension, increases in heart rate, systolic
0.15 HEART RATE - POST EXERCISE blood pressure, and diastolic blood
pressure occur. Mitchell and associates
0.1
and Seals et al suggested that
Female
0.05
Male
cardiovascular responses to isometric
exercise are greater when larger muscle
0
72 82 92 groups are involved. While heart rate
responses to sustained submaximal static
contractions tend not to be significantly
different before, during, or after exercise, These result indicate that more blood is
blood pressure responses to this exercise pumped by left ventricle into aorta in
are significantly elevated before, during, response to upper extremities isometric
and after exercise Gender differences in exercise among males than females; while
cardiovascular responses to static exercise myocardial oxygen uptake & measure of
are believed to be due to differences in oxygen consumption of heart muscles of
sympathetic-parasympathetic or adrenal female participants in response to upper
interactions at the cardiac level. The extremities isometric exercises is higher
finding of this study revealed that there than that of males.
was no significant gender difference in The tissues working hard during exercise
vitals of participants at baseline which and also after the completion of exercise
was statistically significant. The data require more oxygen than normal to pay
collected reveals that post exercise heart off this oxygen debt incurred during the
rate, systolic blood pressure ,diastolic exercise. These results in increase in blood
blood pressure and mean arterial pressure supply to active muscles to supply this
were higher than pre exercise values and extra amount of blood. At rest, muscles
was statistically significant in both groups receive approximately 20% of total blood
ie group A and group B. flow but during exercise blood flow to
When values of recovery i.e. 3 minutes muscles increase to 80 -85% .
after exercise when compared it was Generally ,longer the duration of exercise
almost same in both groups but when greater the role the cardiovascular system
compared to values at rest it was much plays in metabolism and performance
greater than recovery values. during exercise bout.eg an 1T00 meter
The result between the two was calculated walk (little or no cardiovascular
using unpaired t test. Therefore upper involvement) versus a marathon(maximal
extremities isometric exercise had involvement).9
significant effect on heart rate, systolic It has reported that release of adrenaline
blood pressure, diastolic blood pressure and lactic acid into the blood result
and mean arterial blood blood pressure. increase in a heart rate.
When values of group A and group B at The isometric exercises does not increase
post exercise were compared it was seen the oxygen demand to the extend raised by
that male participants (group B) had isotonic exercise thus DBP does not rise
higher post exercise MAP and SBP had much in isometric exercise The isometric
level than females (group A) (p<0.05) exercise results in pressure overload on
heart. The myocardial oxygen extremities isometric exercise in

consumption (mvo2) also increase due to normotensive subjects.” By Cembada and
exercise . Higher ventricular contraction is “Gender differences in cardiovascular
evoked among males leading to increase response to isometric in seated and supine
in systolic blood pressure. positions” by Don Melrose. The proposed
This indicates that the males have higher mechanisms attempting to explain gender
myocardial oxygen demand during differences in cardiovascular responses to
isometric exercise predisposing them to isometric exercise have been numerous
greater risk of ischemia if developing and conflicting. Sanchez et al. found
cardiovascular risk, factor compromising differences in adrenergic patterns between
the coronary blood flow.10 genders in response to isometric exercise
It has been seen males have higher plasma and support the study. Ettinger and
levels of all three catecholoamines out of associates demonstrated attenuated
which plasma levels of epinephrine are increases in blood pressure and muscle
higher as compared to females .this results sympathetic nerve activity compared with
in increase in MAP immediately at of men. In data also derived from static
exercise. exercise as well as temperature and
The findings supports the results of psychological stressors, Jones et al found
previous investigators than upon initiation that gender did not influence sympathetic
isometric tension increase heart rate, neural reactivity to stressors such as
systolic blood pressure and diastolic blood isometric handgrip exercise
pressure occur.12 The result of Changes in posture often experienced
investigations have been reported at best during exercise or sporting activities have
inconsistent and do not follow definite also been shown to elicit various
pattern.12 circulatory adaptations. Sagiv et al. and
However during the recovery period the Borst et al. both noted changes in
vitals were decreased as compared to cardiovascular regulation as a result of
immediately post exercise in both genders. postural changes. Relatively fewer studies
However the vitals were not the same as have investigated the cardiovascular
they were at rest prior to commmencent of adaptations to exercise performed when
exercise. posture does not change during the time
The result of study is supported by the course of the positions.
articles “Gender difference in A further study can be made:
cardiovascular response to upper
• Comparison of vitals for larger pressure ,diastolic blood pressure ,mean
muscles groups to smaller muscles arterial pressure and heart rate among
group in upper limb isometric apparently healthly males and females.
exercises. 2. This was more preannounced in males
• Comparison of vitals in isometric than females .Systolic blood pressure
exercise for upper limb versus (SBP) and Mean arterial pressure (MAP)
lower limb. increased in both but more males as
The result can be used as compared to females
• It can be used for prescription of
exercise in those with LIMITATION
cardiovascular crompromise and 1. The participants in study were young
elderly patients. and elderly or middle aged participants
• It can be used to determine the were not included in these study.
safety limits during exercise 2. All the subjects who were included in
regimen. the study were students.

3. The participants nutritional status or
CONCLUSION BMI were not considered while selection.
The above study gives following 4. The occupation or lifestyle of
conclusion: participants was not considered.
1. Isometric exercises of upper limb can 5. The muscle mass or bulk of upper limb
lead to increase in systolic blood was not considered.
REFERENCES:
1. Journal of Exercise Physiology 5. Effect of exercise .stending
Online. Volume 8, number 5, lenderg 2004
august 2005. 6. Gender difference in
2. Therapeutic Exercise, Carolyn cardiovascular response to
Kisner & Lynn Allen Collby.Pg isometric exercise.gatzke 2005
No 168,5th Edition 7. Circulation, amercian heart
3. Sports Fitness Advisor, Fleck association,2007pg no 3 &4
st&kramerwj(2004). 8. Clinical Orthopaedic
4. Husketh Mount, pg no 92-96,lord rehabilitation ,2nd editions brent
street,merseyside, england. brotzman,pg no 138-142
9. Cardiovascular system and isometric exercise of upper

exercise physiology,aulter &amer limbs,howden et clf 2006.
suleman 12. Gender difference in
10. International journal of biomedical cardiovascular response to
reserach,srinath galag & ravipati isometric exercise,gatzke
sarath volume 2,november 2011 13. The essential guide to building
11. Gender difference in muscles by phil daviee.
cardiovascular response to
CORRESPONDENCE:
* Consultant Physiotherapist, Bhagwan Mahaveer Medical Centre, M.G. Road, Goregaon (W), Mumbai.
Paraplegia with Sacral Pressure ulcer treated by Ultrasound therapy- A
Single Case Report
Shanmuga Raju P. MPT *, Ramalingam P. MS, FICA, MAMS
Abstract: Pressure ulcers are important and common complications after

paraplegia. The use of therapeutic ultrasound as an adjunct to wound healing has
gained interest in recent years. An twenty five year old male reported with a two
months history of a grade two, non healing, sacral pressure ulcer. Ultrasound
therapy (UST) is simple, safe, without side effects, bedside procedure, inexpensive
with positive wound healing results for difficult to treat non healing pressure sore.
I hope that this article will encourage other wound care specialists to engage in
further research in this area.
Key Words: Paraplegia, Sacral pressure ulcer; Continuous mode of ultrasound

therapy; wound healing.
INTRODUCTION
Pressure Ulcer, also called as Decubitus time (9). Pressure ulcer are treated by
ulcers, was first seriously studied by using wound dressings, relieving pressure
“Jean- Martin Charcot”, a clinician in the on the wound, Water beds/ Alpha bed by
19th Century (1-3). Pressure ulcer is a treating concurrent conditions which may
serious health issue, very painful, a delay healing and by the use of physical
significant physiological challenge, can therapy such as electrical stimulation,
shorten the life of patient, an emotional laser therapy and ultrasound (1).
and financial burden to the patient. Ultrasound is now the most frequently
Pressure sore are important and common used electrophysical agent worldwide,
complications after paraplegia. An used at least daily for patient treatment by
estimated 50 – 80% of individuals the majority of physiotherapists (4-5).The
suffering from spinal cord injury develop aim of this study to investigate the effect
pressure ulcer at least once in their life of ultrasound (US) therapy in sacral
pressure ulcer with paraplegia. Limited department of physical medicine and

clinical research is available and no rehabilitation OPD, CAIMS, Karimnagar
consensus exists regarding the efficacy of on February 26th, 2011.
ultrasound for treating pressure ulcer, On physical examination, he is bed ridden
particularly full thickness pressure ulcers. and was unable to sit without support in
the chair, had sustained the sacral pressure
CASE REPORT ulcer. He has bedsore of 6.2 X 4.0 cm, the
A twenty five year old man presented with depth ranging from 10mm, grade II
a two months history of a grade two, non sacrum ulcer with necrotic slough
healing sacral pressure ulcer. He was a according to European pressure ulcer
former. He had history of fall from height. Advisory panel (EPUAP) wound
His past medical history, complete classification system (Figure.1). His
paralysis of both lower limbs, loss of albumin count 2.4 g/dL, haemoglobin 11.0
sensation, urinary and bladder g/dL, temperature was 38 degree Celsius.
incontinence, loss of mobility and sacral There was no evidence of osteomyelitis.
pressure ulcer for past one month. His He was put on conservative treatment,
medical problems included spinal cord consisting of water bed mattress, bed
injury and severe depression. He had postioning, regular pressure relief, daily
become unable to walk since two months saline water dressing and appropriate
and was carried either in bed or in his antibiotics.
wheelchair. He was diagnosed as a case of
D11, and D12 wedge compression of OUTCOMES EVALUATED
spine with traumatic paraplegia (American Wound measurements and digital
spinal cord injury association impairment photographs of wound beds were obtained
score: A- no motor or sensory function in weekly. Wound dimension monitored and
the sacral segments) and sacral pressure depth measurements were obtained using
ulcer. Five month back, he underwent a sterile, cotton-tip applicator and ruler
placement of spinal fixation rods and (Steven JK et al, 2007). Wound surface
plates from D11 to L1 level. A thoraco area was determined using Bates-Jenes
Lumbar-sacral corset was fabricated for wound assessment tool.
him. Routine hematology and
biochemistry investigations were within ULTRASOUND THERAPY
normal limits. He received antibiotics and INTERVENTION
vitamin supplements. He was referred to
On February 2011, Continuous mode of • Pulse duration: 2 ms
ultrasound therapy (Electroson 709, • Duty factor: 0.2
Chennai) treatment was performed in • Spatial temporal average radiating
sacral pressure ulcer region. The surface area: 5.2 cm2
following protocols are applied: • Duration of treatment: 10 minutes
ultrasound machine with frequency of 3 per session for sacral pressure
MHz and spatial average intensity 0.8 ulcer
w/cm2 sound head, in conjunction with a • Duration of treatment: 6 weeks
coupling media of aquasonic ultrasound
transmission gel was used. Ultrasound RESULT
was applied to the outer surface, and edge The indolent pressure ulcer, apart from
of sacral ulcer region (Fig. 2). Before the routine therapy, continuous mode
treatment of CUS therapy, we splashed ultrasound therapy enhanced the healing
each wound by oxygen spray. Sacrum of pressure ulcer in six weeks.
ulcer was cleaned using 2% hydrogen
peroxide. The standard normal saline
(Nacl) dressing was done. Ultrasound
treatment time was 10 minutes per session
6 days a week, for six weeks. At the end
of third week there was marked
improvement in pressure ulcer i.e size,
floor and wound margin reduced. There
was no pus discharge after treatment (Fig.
3). A healthy granulation tissue was noted
(Fig. 4). The patient made good progress
and wound was completely healed within Fig: 1 On assessment, the sacral pressure
ulcer presented as non- healing grade II
42 days (Fig. 5).
pressure ulcer measuring 6.2 x 4.0 cm
with erythema.
Table: 1 Parameter of Ultrasound
therapy treatment (McDiarmid etal, 1985)
• Ultrasound frequency: 3 MHz
• Spatial average temporal peak
intensity: 0.8 W/cm2
Fig: 5 After six week of treatment, picture

Fig: 2 the full thickness of sacral ulcer
showing that sacral pressure ulcer are
was treated with continuous mode
completely healed.
ultrasound therapy (CUST)
DISCUSSION
The purpose of the study was to assess the
effect of ultrasound therapy in healing of
sacrum pressure ulcer in patients with
paraplegia. Infected sores heal more
slowly than clean sores while no effect of
ultrasound clean sores were observed
ultrasound therapy appeared to improve
Fig: 3 three weeks after the treatment of the rate of healing of infected sores. It is
CUST non thermal effect produced by ultrasound
that are most significant in the stimulation
of tissue repair (Dyson, 1976). Paul et al
(1960) ultrasound was effective in
relieving congestion, cleansing necrotic
areas and promoting healing with healthy,
non-adherent skin approaching normal
thickness. Cyclic vibration effect of
ultrasound might induced a form of micro
massage which by reducing edema, might
Fig: 4 Fifth weeks after CUST, the wound facilitate repair, their requires further
size are decreased for sacral ulcer investigations. It is also stimulate protein
synthesis infact ultrasound initiates two
processess which results in release of cm2, Duration of treatment 10 minute
energy tissue: Surface cavitation (creation per/session, Duration of frequency 6
and dissipation of tiny bubbles in the weeks) pressure ulcer healed in time
tissues) and acoustic microstreaming that without side effects. Our case study
is movement of fluids along acoustic showed that continuous mode of
boundaries, such as cell membrane. This ultrasound therapy treatment enhances
biophysical effect that are non-thermal healing of sacral pressure ulcer. This case
alternations in cellular protein synthesis study confirmed that continuous UST has
and release, blood flow and vascular a positive effect on pressure ulcer with
permeability, angiogenesis, and collagen paraplegia (Fig.5). No complications were
content and alignment by various workers observed with application of the
it as quoted as follows: 1. General protein continuous ultrasound. Further studies are
and collagen synthesis by fibroplasts needed to evaluate the efficacy of
(Harvey etal, 1975, Webster etal. 1980). 2. ultrasound therapy in pressure ulcers in
Fibroplast mobility (Miller etal, 1978). 3. spinal cord injury in a large number of
Fibroblast ultrastructure (Dyson and Pond, patients.
1970). 4. Permeability of fibroblast
membrane (Harvey etal, 1975). 5. CONCLUSION
Lysosomal fragilty (Tayor and Pond, Continuous mode of ultrasound therapy
1972). 6. Tensile strength and elasticity of was effective in the treatment of patient
scar tissue (Dyson et al, 1979). 7. with grade II pressure ulcer in young
Modification of contraction in skin paraplegic patient. Ultrasound therapy
wounds (Dyson et al, 1981). treatment of pressure ulcer is less
With this parameters of ultrasound expensive, more comfortable and can
treatment (frequency 3 MHz, Intensity 0.8 enhance wound healing process without
W/cm2, Pulse duration 2 ms, Duty cycle side effects and complication.
0.2, effective radiating surface area 5.2
REFERENCES:
1. Sella EJ, Barrette C. Staging of
charcot neuro arthropathy along 2. Levine JM. Historical perspective
the medial column of the foot in on pressure ulcers: The decubitus
the diabetic patient. J. Foot Ankle ominosus of Jean- Martin Charcot.
Surg. 1999, 38; 34-40.
J Am. Geriatr. Soci, 2005, 53; 8. Callam MJ, Dale Jj, Harpel DR,
1248- 1251. etal. A controlled trial weekly
ultrasound therapy in chronic leg
3. Levine JM. Historical perspective: ulceration, Lancet. 1987; ii; 204-
The neuropathic theory of skin 206.
ulceration. J. Am.Geriatr.Soci,
1992; 40, 1281. 9. Saad A, Williams A. Effect of
therapeutic ultrasound on the
4. Goh AC, Chock B, Wong WP et al. activity of the mononuclear
Therapeutic ultrasound rate of phagocyte system in vivo.
usage, knowledge of use, and Ultrasound Med Biol, 1986; 12;
opinions on dosimetry. Physiother 145-150.
Singapore 1999; 2: 69-83.
10. Steven JK, David AL, Andrea JB,
5. Chipchase LS, Trinkle D. Jenny LM, Julie AB, Karen LA.
Therapeutic Ultrasound: Clinician Expedited wound healing with
usage and perception of efficacy. Non-contact, Low frequency
HongKong Physio Ther J. 2003; ultrasound therapy in chronic
21: 5-13. wounds: A retrospective analysis.
Adv. Skin and wound care, 2008,
6. Ali Akbari S, Flemming K, vol: 21 (9); 416-23.
Cullum NA, Wollina U.
Therapeutic Ultrasound for 11. Arthro PJ, Thyme B, Warring
pressure ulcers, (2009). The (2002). A Calibration study of the
Cohrane collaboration, John wiley ultrasound unit, Phys Ther, 82;
and Son ltd, p:1-18. 257-263.
12. Ankrom MA, Benneh RG, Sprigle
7. Paul BJ, Lafratta CW, Dawson AR S, et al. Pressure related deep
etal. Use of ultrasound in the tissue injury under intact skin and
treatment of pressure sores in the current pressure ulcer staging
patients with spinal injury. Arch systems. Adv. Skin Wound care,
phys Med Rehabil, 1960; 41; 438- 2005; 18 (1); 35-45.
440.
13. McDiarmid T, Burns PN, Lewith 16. TerRiet G, Kessels AG,
GT, Machin D. Ultrasound and the Knipschild P (1996). A
treatment of pressure sores, randomized clinical trial of
Physiotherapy, 1985; 71; 66-70. ultrasound in the treatment of
pressure sores. Phys Ther 76;
14. Dyson M. Role of ultrasound in 1301-1311.
wound healing. In: Mcculloch JM.
Kloth LC, Feeder JA, eds. Wound 17. Whatson GW, Milani JC, Dean LS.
Healing. Alteratives in Pressure sore profile: cost and
Management, 2nd ed, Philadelphia management, ASIA, Abstracts
Pa: FA Davis co; 1995; 319-345. Digest, 1987; 115-119.
15. Sari AA etal. Therapeutic 18. Houghton PE, Kincaid CB,

ultrasound for pressure ulcers. Campell KE, et al. Photographic
Cochrane Database of systemic assessment of the appearance of
reviews. 2009 (4). chronic pressure and leg ulcers.
Ostomy / Wound Management.
2000; 46(4); 20-30.
ACKNOWLEDGMENT:
I thank the men who participated in this trial. I would also like to thank chairman Sri. C.
Lakshmi Narasimha Rao, Prof. V. Suryanarayana Reddy, Director, Chalmeda Anand Rao
Institute of Medical Sciences, Karimnagar for his support and encouragement of this study.
CORRESPONDENCE:
*Asst. Professor & I/C Head, Department of Physical Medicine and Rehabilitation Chalmeda Anand Rao
Institute of Medical Sciences Karimnagar -505001, Andhra Pradesh, INDIA. Mobile: 08790544270, Fax: 0878-
2285318. E-mail: [email protected]
Arterio-Enteric Fistula: A Case Report

Anil Degaonkar*, Nikhil Bhamare**, Mandar Tilak***
Abstract: Gastro-intestinal (GI) bleeding may originate anywhere from oral

cavity to anus from the innocuous one like peptic ulcers to capricious lesion like
ca colon.Classically if the cause of bleeding is somewhere below the ligament of
Treitz, the stools are maroon or bright red in colour and it is described as lower
GI bleeding or hematochezia. Arterioenteric fistula signifies a rare but important
cause of massive lower GI bleeding .The vexing problem lies in proper and timely
diagnosis of this condition.A keen clinical acumen and proper use of tests lead to
accurate diagnosis and prompt treatment and can be lifesaving for the patient by
treating significant ongoing bloodloss. We wish to report such a case of an
arterio-enteric fistula between artery of broad ligament of uterus and terminal
ileum diagnosed and successfully treated at our institute .
Keywords: Arterioenteric fistula, massive GI bleed, rare cause
INTRODUCTION
Arterioenteric fistula is a anomalous anemia. She had undergone exploration
communication between artery & for ectopic pregnancy 1 month back at a
gastrointestinal tract. It is a rare cause of private hospital..On 8th post operative day
massive lower GI bleeding with the she had complained of three episodes of
dreaded aortoenteric fistula leading to per rectal bleeding which was associated
massive and many times fatal GI bleed. with giddiness and profound weakness.
Her sigmoidoscopy had been done and no
CASE REPORT abnormality was detected.Patient had been
A 28 yr lady presented with complains transfused, stabilised and subsequently
of recurrent per rectal bleeding and severe discharged .She whad been stable for the
next 20 days and now presented with exploratory laparotomy after proper
above complains of recurrent per rectal resuscitation of the patient was taken.
bleeding and severe
ere anemia. Patient was On exploratory laparotomy there was
investigated. Hematological investigations evidence off adherent ileum to the
showed low haemoglobin hb-55 gm% with posterior aspect of the broad lig. of
reticulocytosis. Platelets were adequate uterus (site at which the gestational sac
and bleeding and clotting time was normal. of previous ectopic was present.) Ileum
Serum Beta hCG was elevated .Upper GI was separated from adhesion site. Erosion
scopy showed no abnormality. O
On of ileum wall with bleeder at site of
colonoscopy only significant finding adhesion to broad
ad ligament was found.
observed was presence of blood clots near The site of adhesion on the broad ligament
caecum. USG was suggestive of showed necrosis.
heterogeneous mass in right adnexa with
left ovarian cyst. CT confirmed the
ultrasound findings.
Pt was transfused with 3 pints of PCV.
Her condition
ition improved and she remained
stable for next 8 days .On 9th day she
developed three episodes of massive per
Fig.1: Involved Ileal Segment
rectal bleed and went into hypovolemic
shock. Her pulse rate was 146/min, BP Thus this was a case of arterioenteric
90/60 mm of hg. Patient was pale and fistula between the adherent ileum and a
dehydrated. She did not have an
any branch of the ovarian artery supplying the
hematemesis and ryle’s tube aspirate was broad ligament. All
ll bowel adhesions were
clear. Due to absence of hematemesis and separated. The bleeder as ligated
pain in epigastrium upper GI bleeding was hysterectomy was done. Adherent and
less likely. Also patient had a history of eroded segment of ileum was resected.
abdominal exploration. Thus an Intra-operative
operative enteroscopy both
arterioenteric fistula was suspected. antegrade and retrograde was done in the
Advanced investigation
tion modalities like ileum to rule out any othe site of GI bleed.
angiography and technicium99 labelled Ileo-ileal
ileal anastomosis was done.
rbc scan was unavailable at our institute. Postoperatively the patient was monitored
Hence a decision for emergency in surgical intensive care unit. Patient
received 3 blood transfusions. Patient’s tuberculosis, non steroidal anti

anti-
general condition improved steadily and inflammatory drug enteropathy and
patient was discharged on 14th post enteric fever are the major causes of lower
operative day. GI bleeding in India.2,3 Small bowel
tion of resected specimen of
Gross observation sources and other colonic pathologies like
ileum and uterus with broad ligament as small bowel diverticular disease,
well as histopathological analysis inflammatory bowel diseases, neoplasia of
suggested a arterio-enteric
enteric fistul between small and large bowel, angiodysplasia,
the ileum and the broad ligament of the aorto-enteric
enteric fistula, ischaemic and
uterus. radiation colitis are uncommon causes but
pose a challenge to the clinician in making
correct preoperative diagnosis.3,4
It is imperative to localize the source of
bleeding preoperatively for successful
treatment. Only rarely does laparotomy
need to be performed in emergency
without knowledge of the s
site of
hemorrhage.5 The diagnostic work-up
work
should be done as soon as the resuscitation
is over and the general condition stabilizes.
The first step is nasogastric aspiration and
upper gastrointestinal endoscopy
Fig.2. & 3: Resected
esected specimen of uterus (esophago-gastroduodenoscopy)
gastroduodenoscopy) to rule
(gross) out upper
er GI hemorrhage since peptic
ulcer bleeding may be the cause of
DISCUSSION hematochezia and malena. Proctoscopy
The causes of lower GI bleeding shows a and sigmoidoscopy (rigid or flexible) are
geographical variation, wit colonic relatively simple procedures to exclude
diverticulitis and vascular ectasia of colon hemorrhage below the peritoneal
are the most common causes in the West.1 reflection such as bleeding internal
Idiopathic ulcerative colitis, acute colitis, hemorrhoids,
orrhoids, rectal polyps and growths.
colonic polyps, solitary rectal ulcer, Colonoscopy, visceral angiography and
colonic carcinoma, ileal and colonic abdominal scintigraphy with 99m Tc
labeled RBCs are three useful tests for
localization.5 Colonoscopy may be most adhesion formation as seen sometimes as
useful if the bleeding has stopped or at a sequele of mesenteric venous thrombosis,
least slowed substantially. malignancies and fungal infection. A case
Selective visceral angiography is very has been reported where mucomycosal
useful if the patient is having active invasion took place into the iliac artery
bleeding to locate exact site of bleeding. causing severe haemorrhage, in a case of
Abdominal scintigraphy with 99m Tc non Hodgkin’s lymphoma receiving
labeled RBC infusion is helpful in chemotherapy.8 In this case, the cause of
delineating the site of bleeding when arterio-enteric fistula formation was due to
bleeding is intermittent and at a rate below continued trophoblastic activity of
that which is detectable by angiography. incompletely removed gestational sac &
In case the above facilities are not at hand, as the syncytiotrophoblast has invading
a combination of sigmoidoscopy and air property.9 It has eroded the ileum &
contrast barium enema may be tried if fistula is formed between uterine artery of
patient’s general condition permits.6 We broad ligament & terminal ileum.
have searched the literature on the subject Monitoring of trophoblastic activity can
and have come across some pathological be done by estimation of serum beta HCG
conditions leading to fistula formation levels.10
between aorta and the intestine.7,8 In the above case report we have
Abdominal aortic aneurysm and infective presented a case of arterio-enteric fistula
aortitis may lead to primary aorto-enteric between ileum and broad ligament of the
fistula but in most of the cases the uterus. This is a very rare pathology and
bleeding occurs due to erosion of aortic has seldom been reported. We hypothesize
vascular prosthesis through the wall of that the ectopic pregnancy and exploratory
distal duodenam due to prolonged contact laparotomy for the same probably created
between prosthetic graft and a fixed a inflamed and eroded surface on the
segment of intestine (secondary aorto- broad ligament where ileum adhered. The
enteric fistula). Bleeding may occur due ileal wall was further eroded .The
to dehiscence of the anastomosis with inflammatory process exposed a artery on
bleeding into the bowel lumen from the the broad ligament and this adhered to the
edges of the eroded intestine.7 ileum cresting the arterioenteric fistula.
The intestine may take blood supply from
the anterior abdominal wall due to
REFERENCES:
1. DeMarkles MP, Murphy JR. Acute Invest Clin 2002 Mar-Apr;
lower gastrointestinal bleeding. 52(2):119-24.
Med Clin North Am 1993 Sep;
77(5):1085-100. 6. Mark HB, Robert B, Mark B.
Merk Manual Diagnosis and
2. Goenka MK, Kochhar R, Mehata Therapy. Seventeenth Edition Sec
SK. Spectrum of lower – 3, Ch-22. Gastrointestinal
gastrointestinal hemorrhage: an Bleeding.
endoscopic study of 166 patients.
Indian J Gastroenterology 1993 7. Kahhlke V, Brossmanm J, Klomp
Oct; 12(4):129-31. HJ. Lethal hemorrhage caused by
aortoenteric fistula following
3. Anand AC, Patnaik PK, Bhalla VP, endovascular stent implant.
Choudhary, et al. Massive lower Cardiovasc Intervent. Radiol 2002
intestinal bleeding – a decade of May-Jun:25(3):205-7.
experience. Trop Gastroenterol
2001 Jul-Sep;22(3):131-4. 8. Mir N, Edmonson R, Yeghen T,
Rashid H. Gastrointestinal
4. Miller LS, Barbarvech C, mucormycosis complicated by
Friedman LS. Less frequent causes arterio-enteric fistula in a patient
of lower gastrointestinal bleeding. with non-Hodgkin’s lymphoma.
Gastroenterol Clin North Am Clin Lab Haematology 2000
1994 Mar;23(1):21-52. Feb;22(1):441-4.
5. Gracia Osogobio S, Remes Troche 9. Datta; textbook of

JM, et al. Surgical treatment of gynaecology;6th edtn;chapter
lower digestive tract hemorrhage – 2;page no.23
Experience at the Institute
Nacional de ciencias Medicas Y 10. Datta; textbook of
Nutricion Salvador Zubiran.Rev gynaecology;6th edtn;chapter
15;page no.186.
CORRESPONDENCE:
*Assistant Professor Surgery, Dr. Shankarrao Chavan Govt Medical College, Nanded, Maharashtra;
**Resident 3rd yr General Surgery, Dr. Shankarrao Chavan Govt Medical College, Nanded, Maharashtra;
***Assistant Professor Surgery, Dr. Shankarrao Chavan Govt Medical College, Nanded, Maharashtra. E-mail
id: [email protected] Mob no: 09975033726
All-Oxide Solar Cells: The Way of the Future

Akshay Vijay Dongarwar*
Abstract: We as a world are looking at our globe depleting of its natural

resources. The quantity of coal presently available can lead us through for twenty
more years at maximum considering the growing demand for high quality coal
and natural resources and to suffice the growing population and bettering
lifestyle. Again, on one side we have cut throat technological advancement in the
silicon valley and the mobile world and on other, we have fairly advanced
technologies for bringing in better, faster, more efficient and cheaper solutions to
the environmental concerns. The question is basically inspired from this ever
daunting situation. Can’t we have a cheap and highly effective solar energy
treatment plant which can actually reach poor countries and help them get over
their energy crisis without undergoing high-end processing in posh labs like is
done for silicon cells? Even in one of the fastest growing economies of world,
India, silicon processing is not done by any industry commercially to make solar
cells. All the pre-processed cells are imported and further distributed because of
the complexity in the process. Also, being cheap and easily available, it must have
a huge life like silicon cells have. So, it should possess the best of silicon while
eliminating the negatives. Can we find an alternative to conventional solar cells
that can reach out to everyone?
Keywords: All Oxide Solar Cell
THE QUESTION
We as a world are looking at our globe demand for high quality coal and natural
depleting of its natural resources. The resources and to suffice the growing
quantity of coal presently available can population and bettering lifestyle. Again,
lead us through for twenty more years at on one side we have cut throat
maximum considering the growing technological advancement in the silicon
valley and the mobile world and on other, polish of cavity from atmospheric reaction.
we have fairly advanced technologies for Such cavity behaves as metal-metal
bringing in better, faster, more efficient junction solar cell (termed M-M cavity
and cheaper solutions to the solar cell).
environmental concerns. The question is But using nanowires and nanotubes
basically inspired from this ever daunting increases the functionality further as
situation. diffraction light rays occurs. Again, using
Can’t we have a cheap and highly metal oxide makes further sense as they
effective solar energy treatment plant are chemically under thermodynamic
which can actually reach poor countries equilibrium. Another approach is used
and help them get over their energy crisis which is of titanium dioxide for photo-
without undergoing high-end processing sensitization.
in posh labs like is done for silicon cells?
Even in one of the fastest growing RESEARCH
economies of world, India, silicon The main challenge with producing a solar
processing is not done by any industry cell with whole new materials is the
commercially to make solar cells. All the availability of photo sensitive materials
pre-processed cells are imported and and their production. I had prepared a
further distributed because of the project for the prestigious “KVPY”
complexity in the process. Also, being scholarship, where I tried to theoretically
cheap and easily available, it must have a explain the use of metal-metal junction
huge life like silicon cells have. So, it cavity cell for emitting electrons. The
should possess the best of silicon while same research is used here, but with some
eliminating the negatives. Can we find an changes to make it further effective and to
alternative to conventional solar cells that eliminate short-comings. Here, I present
can reach out to everyone? an all-oxide solar cell fabricated from
vertically oriented zinc oxide nanowires
HYPOTHESIS and cuprous oxide nanoparticles. It
A cavity of metal m2 (W2) with thin consists of vertically oriented n-type zinc
polish of metal m1 (W1, W1<W2) on oxide nanowires, surrounded by a film
inner surface, with a pin hole is kept at the constructed from p-type cuprous oxide
focus of the solar concentrator coinciding nanoparticles. The idea behind using
the pinhole and focus. Pinhole is covered metal oxides is to eliminate the effects of
with transparent glass to protect inner atmosphere. Oxides being benign, are safe
from environmental contamination. The 5 mM solution of zinc acetate dihydrate in

use of cuprous oxide as solar cells is a absolute ethanol was prepared. Two drops
very well studied since last 20 years. of this solution were placed onto an
Adding another metal-oxide film seemed indium tin oxide (ITO) coated glass
difficult at first as the oxides are already substrate (Thin Film Devices, ~40-50
in stable states and to make use of metal- Ω/square). The substrate was then rinsed
metal junction films, we had to change the with absolute ethanol and blown dry with
physical properties to excite them. But, nitrogen. The dropcasting, rinsing and
with the knowledge of photo-electricity drying was repeated four times per
(diffusion) that I had acquired in the substrate. The substrates were then
recent months made me think a step annealed in air at 350°C for 30 minutes,
further and the idea of using nanowires converting the Zn(OAc)2 into ZnO, and
and nano-particles that respond better to then cooled to room temperature. This
incident light seemed possible. process was then repeated a second time
In the second part, I used titanium dioxide, to ensure a conformal layer of ZnO.
another successful oxide to take in the The nanowires were then grown by
solar light and convert them into placing the seeded substrate in an aqueous
electricity (Research done by Dr. M. solution containing 25 mM zinc nitrate
Graetzel ). The cell was not taken as it hexahydrate, 25 mM
was. I just used pure titanium dioxide dust hexamethylenetetraamine, and 5 mM
here as polyphyrine derivatives. I did not polyethyleneimine at 90°C. The substrate
use dyes as is done in Graetzel cell but was suspended upside-down to prevent
instead let the oxide in white colour. Its any larger ZnO aggregates from
property of reflecting back visible range accumulating on the surface. Typical
light was later used and sorted out with growth times ranged from 30-60 minutes,
design. Being from an engineering yielding wires that averaged from 400-
background, I designed a model, that 1000 nm in length and 30-50 nm in
could make use of both these oxide films diameter. After the growth, the nanowire
efficiently and expected to get a desired arrays were rinsed thoroughly with
output of >12% efficiency. deionized water, then annealed at 400°C
for 30 minutes to remove any residual
EXPERIMENT organics on the nano wire surface.
Zn oxide film preparation:
air. After 12 hours, the burgundy solution
turned into deep green, indicating the
oxidation of the copper nanoparticles into
Cu2O. The Cu2O nanoparticles underwent
further cleaning by repeated precipitation
with ethanol. Finally, the nanoparticles
were dispersed in toluene for dropcasting
onto the ZnO nanowire arrays.
The processing required no posh research
labs and could be done without much
efforts.
The titanium oxide film is prepared the
usual Graetzel cell way. Except, we do not
use dye. The main motto was to simplify
the process. Dying induces lot of
The Cu2O nanoparticles (NPs) were complexity and we want the process to
prepared as follows: remain easy.
A solution of copper (I) acetate (0.5 g),

trioctylamine (15 mL) and oleic acid (Alfa DATA
Aesar, 99%, 4 mL) was flushed with The complete experiment was done by
nitrogen, then rapidly heated to 180°C using the available technologies at
under nitrogen flow. The solution was disposal. Instead of using the paraboloid
maintained at this temperature for 1 hour, sun-tracking reflector concentrator, a fine
then was quickly increased to 270°C and beam of SODIUM VAPOUR LAMP was
held for one additional hour, ultimately used to create a similar effect. The metal-
producing a burgundy colloidal solution, metal oxide junction solar cell and the
which are metallic copper nanoparticles. titanium oxide cell were tested over a long
The solution was cooled to room period of time to get accurate readings.
temperature, at which point absolute The cuprous oxide-zinc oxide junction
ethanol was added to precipitate the cells were studied first as they formed the
nanoparticles. The supernatant was key research. A fine layer of the junction
removed and the nanoparticles were nanoparticles was taken and placed in a
redispersed in hexane and then exposed to small glass box. The glass was designed in
such a way that it didnt let the incident
light get out and caused multiple internal

reflections, thereby reproducing the effect OBSERVATION
as we see in the model. The input currents The observations of the experiment that I
and output currents were first measured performed are listed below
for a silicon solar cell of known efficiency. For the Metal-metal oxide junction cell:
It gave the total losses caused due to Sr Voltage Output
No (V) Current
atmosphere and other resistances in the
(mA)
wire. Considering the same,the silicon 1 11.5 100
solar cell was replaced by the meta-metal 2 10.6 99
junction cell. Calculating the output
3 11.4 100
currents for same input current given t
sodium vapour lamp and subtracting the
Max power point 1.146 w
effects of losses previously calculated, the
Light irradiance 1000 w/m^2
efficiency was calculated to be
Area is 12*8cm^2 or 0.0096 m^2
The details of the experiment are given as
Efficiency=11.9374
follows
There were mainly 2 methods employed
For the titanium dioxide cell
to double check the results
Sr Voltage Output
1) V-A meter, where voltage of input was No (V) current
noted and then the output current. Thus (mA)
1 10.2 100
the power of cell was measured.
2 10.3 100
2) A solar cell's energy conversion
efficiency (eff), is the percentage of 3 10.2 99
incident light energy that actually ends up

as electric power. This is calculated at the Max power point 1.0243
maximum power point, Pm, divided by Light irradiance 1000w/m^2
the input light irradiance (E, in W/m2) Area is 12*8 cm^2 or 0.0096 m^2
under standard test conditions (STC) and Efficiency= 10.6697
thesurface area of the solar cell (Ac in m2).
eff=P/EA Now, we observe that the efficiency of the
Similar procedure was carried out for proposed cells with the given design
Titanium dioxide cell. comes out to be quite more than that of the
The net efficiency was found out as silicon cells. Thus, one coupling the cells,
12.2374% the efficiency will increase further.
Here, an interesting trend observed is that importing silicon cells was never cheap.
the maximum power point doesn't change Hence, here, with technologically
much for a considerable change of input advanced institutes in the nation like IITs
voltage in case of metal-metal oxide and NITs the implementation and
junction cells. The reason is unknown. bettering the scope of the idea can be done.
A major issue was designing.
CONCLUSION • How could we make most of the
Thus, as the results showcase, using some sunlight. The answer came with
of the most common oxides and some the paraboloid concentrator.
simple primary treatment processes • How could we use it at all times
coupled with engineering ideas, we were during the day? The secret lied
able to increase the efficiency of solar with the solar tracking device
energy harnessing devices by an which had become pretty common.
outstanding ~6-7% (results show 4.3% but • How would we place the cells to
that is under lab conditions). get output from both? The design
Thus, the basic idea of trying to use the came to me by instincts. After a
metal oxides arising from a simple urge to host of designs, the most suitable
use environmentally inert materials turns and easy to construct was used.
out to be a revolutionary alternative for • Titanium di-oxide reflects back the
the conventional silicon solar cells. The visible light. I offered a solution in
trait that make the idea highly successful the design.
is that the processing is very easy and can • At some places, the solar energy is
be done on a commercial level with some directly used for heating purposes.
material engineering guidance. Also, it Thus a band filter can be employed
turns out to be a relief for countries like to filter out the harmful ultraviolet
India and other developing countries as and infra-red light.
CORRESPONDENCE:
*29, Nelco Housing Society, Near Nagarjuna Trust Hospital, Khamla-Nagpur-440025. Contact- +91
9175017645, Email-id: [email protected]
Call for Papers

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THE COMPLETE VOLUME 1

Scientific Research Journal of India

Scientific Research Journal of India ( SRJI )

Dr. Popiha Bordoloi, Ph.D.

Vermicompost: A Source of soil fertility management in organic farming

P. Bordoloi*, A. Arunachalam**, K. Arunachalam*** & S.C. Garkoti****

Key words: Vermicomposting technology, biodegradable waste, Arunachal Pradesh.

Material and Methods

An experiment was conducted to evaluate Industries Commission (KVIC), Midpu,

Results and Discussion

Table 1. Cost of production of non tank vermicomposting unit (bamboo beam)

1st year 2nd year 3rd year

Table 2. Production of vermicompost in non-tank vermicomposting unit (bamboo beam)

Production in one harvesting 10q 10q 10q

Table 3. Cost of production of tank type vermicomposting unit (cemented type)

1st year 2nd year 3rd year

Table 4. Production of vermicompost in tank type vermicomposting unit (cemented type)

1st year 2nd year 3rd year

Production in one harvesting 10q 10q 10q

Growth Status among Females of Solan District of Himachal Pradesh

Key words: Anthropometry, Rajput females, Body Mass Index.

Table1: Basic information of Rajput females in different age groups.

Table2: Adiposity assessed by BMI, WHR, WC, GMT

Variables BMI GMT

*p<0.05 **p<0.01 ***p<0.001

Table3: The various physiological variables of the subjects.

Discussion in study conducted by the Abbassi (2000). It is

Sinha R and Kapoor S. 2006 Parent-Child

Exploration of the History of Physiotherapy

Krishna Nand Sharma* BPT, MPT (Neuro)

Abstract: Physiotherapy or Physical Therapy or PT, is a conservative science of the treatment

Physiotherapy or Physical Therapy The Maharashtra OT PT Council defines

1. http:/ / www. apta. org/ / AM/ Template. 4. American Physical Therapy

Effectiveness of Proprioceptive Training over Strength Training in

Kuki Bordoloi* MPT (Neuro), Nidhi Sharma** MPT (Neuro)

Key words: Balance, fall prevention, Strength training, Proprioceptive training.

Cerebral palsy is an umbrella term It is caused by damage to the motor

cognition, communication, and behaviour, ways and to varying degrees in each

Muscle strength is another factor Recent research has focused on muscle

Sample selection Children below 8 years and above 14

Timed up and go scale provides a reliable they were referred to physiotherapy

3. Hip Extension Exercise Proprioceptive Training

RESULTS & INTERPRETATION:

Thirty Cerebral Palsy patients were part of In Group A, 15 subjects with an

Table 1.1: Comparison of Gender of patients in both groups

Table 1.2: Comparison of Mean and SD of Age of Patients in both groups

Male 12.8 1.25

Female 11.3 3.20

Male 11.8 1.80

Group A 12.4 1.96

Group B 12.1 1.79

Mean N Std. Deviation

TUGAPR 23.667 15 1.799

TUGAPS 19.933 15 1.534

TUGBPR 23.333 15 1.676

TUGBPS 21.000 15 1.414

Mean N Std. Deviation

PBSAPR 42.1 15 1.792

PBSAPS 47.3 15 2.086

P. Bordoloi, A. Arunachalam, K. Arunachalam & S.C. Garkoti****

p<0.05 p<0.01 p<0.001

Thanigaivel.V, V. Subramanian, K. Priyadharsan