Surabaya Physical Medicine and Rehabilitation Journal

Role of exercise in severe COVID-19 case

Arnengsih Nazir — 2023-08-28

Abstract

Severe COVID-19 infection can lead to prolonged recovery and troublesome symptoms. The symptoms reported in those patients were dyspnea, fatigue, weakness, anxiety, and activity intolerance. Patients showed limited exercise capacity and interfered with daily activities, as well as the quality of life. We report the role of exercise in improving activity tolerance in a survivor of a COVID-19 severe case. A male patient, 51 years, came to outpatient pulmonary rehabilitation after hospitalization due to a severe case of COVID-19. The patient had a low activity tolerance presented as fatigue, dyspnea, activity-induced oxygen desaturation, and inability to perform exercise testing, in addition to mild anxiety. A set of exercises consisting of breathing, flexibility, muscular, and cardiorespiratory endurance were given for 4 weeks along with psychological counseling. Barthel Index, cardiorespiratory fitness, sit-to-stand test, Fatigue Severity Scale, Medical Research Council Dyspnea Scale, and maximum breathing capacity were recorded as outcome measures. A Zung Self-rating Anxiety Scale and insomnia severity index were also measured. After 4 weeks, the symptoms of activity intolerance decreased. There were improvements in all outcomes except for the insomnia severity scale. Experts recommend that COVID-19 patients should carry out regular daily activities and low to moderate-intensity exercise in the first 6-8 weeks after discharge. Resuming daily physical activities as early as possible can affect functional recovery. It is also beneficial for general fitness, fatigue, emotional disturbance, and lack of confidence. In this patient, low-intensity exercises as recommended by experts were given to improve activity tolerance.

The effect of physical therapy and modalities on frozen shoulder patients at Baptist Hospital Batu: a retrospective study

Nadia Ovianti — 2023-08-28

Introduction: Frozen shoulder was one of top 10 diseases with frequent visits at Baptist Hospital’s rehabilitation clinic in 2020. Treatment for this condition includes physical therapy and modalities. This study aims to compare the range of motion and pain scale before and after treatments on frozen shoulder patients in Baptist Hospital Batu.

Material and Methods: This is a retrospective study using the data from medical records of patients known to have frozen shoulder who came to outpatient physical rehabilitation clinic at Baptist Hospital, Batu, for at least a month period of treatment. The parameters used are range of motions after interventions, pain scale using VAS, sex, and age.

Result: Twenty-two patients were diagnosed with frozen shoulder, 16 patients were included in further analyses, 9 of 16 were women, and the most common age presentation was between 50-60 years. There were improvements in 12 patients being recorded for their shoulder flexion and abduction. The flexion ROM increased from 115 to 156 degrees, while abduction ROM increased from 95 to 144 degrees, on average. About 9 out of 13 patients had decreasing pain scale according to VAS, declining from 5.5 to 4.7.

Conclusion: The combination of physical exercises as well as SWD / ultrasound with TENS (transcutaneous electrical nerve stimulation) has a positive impact on the improvement of frozen shoulder. There was an increase in the range of motion of the joint flexion and abduction, and a decrease in pain scores in the majority of the patients after treatment.

Spinal Dural Arteriovenous Fistula in a Pediatric Patient with History of Endovascular Therapy Failure: A Case Report

Primadenny Ariesa Airlangga, M.D, M.Sc — 2023-08-28

Spinal Dural Arteriovenous Fistula (SDAVF) cases in children are extremely rare and pose a high risk for intraoperative hemorrhage. The clinical manifestation and imaging results may be vague and deceptive, frequently mistaken for other conditions such as demyelinating or spinal degenerative illnesses. SDAVF's cause is not well understood. Here, we present the case of a 10-year-old male patient with SDAVF who did not improve after endovascular therapy. The patient complained of weakness in the lower extremities, skin thickness, tingling sensations, and painful bowel movements and urination. The patient underwent endovascular embolization due to spinal AVF from the 9^th thoracic vertebrae until the sacral vertebrae one month earlier. But no significant clinical improvement was found. The vital signs of the patient were within normal limits. An MRI showed a flow-void lesion with tortuosity in the dorsal spinal area at the 9th and 10th thoracic vertebrae. Because an embolization procedure was performed on the patient, which resulted in no significant improvement, it was planned for the patient to undergo an MRI and MRA evaluation. An MRI and MRA later showed the formation of an extramedullary intradural cyst at levels T9 to T10 of the thoracic vertebrae. Decompression surgery (left hemilaminectomy) and tumor extirpation were thereafter carried out on the patient after the routine laboratory test was performed. After the procedure, the patient showed improvement and could carry out everyday activities independently at 10 months post-operatively. The failure of endovascular therapy can be attributed to several factors, such as the surgeon’s experience, tools, and embolization technique, and follow-up treatment by surgery.

Comparing the Effect of Repetitive Transcranial Magnetic Stimulation Therapy and Aerobic Exercise as an Add-on Therapy on the Cognitive Function of Patients with Depression

Ikhwan Muhammad — 2023-08-28

Background: Cognitive disturbances are a major cause of disability in depression. The antidepressant medication effectively improves cognitive function. However, its adverse effect limits its use, so add-on treatment is needed to support its effectiveness.

Aim: This study aims to compare the efficacy of aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) as an add-on treatment for improving cognitive function.

Material and Methods: Twenty-seven patients with first episodes of moderate and severe depression were recruited from the outpatient psychiatry clinic to join this randomized controlled trial. Participants were allocated to three groups: antidepressant only, antidepressant with add-on aerobic exercise, and antidepressant with add-on rTMS therapy. All participants received 2 weeks of intervention. Cognitive functions were assessed using Montreal Cognitive Assessment (MOCA).

Results: No differences were found in baseline characteristic data between groups. Total MOCA score increased after intervention in a group with no add-on treatment (p=0.007), with add-on aerobic exercise (p=0.011), and with add-on rTMS therapy (p=0.017). Hence, there was no between-group difference (p=0.222). The MOCA subtest analysis revealed between-group differences in changes in delayed recall subtest score (p=0.01). The group with add-on rTMS therapy improved better than the group with antidepressants only (p=0.005).

Conclusion: The addition of rTMS therapy resulted in better improved delayed recall function than the addition of aerobic exercise or without any add-on treatment. This finding supports the application of rTMS therapy as an add-on treatment to improve the cognitive function of patients with depression.

Effect of Adding Kinesiotaping to Median Nerve Gliding Exercise Toward Hand Performance of Patients with Carpal Tunnel Syndrome by Using Michigan Hand Outcomes Questionnaire

Ratih Dwiratna Hakim — 2023-08-28

Background: CTS occurs due to local compression of the median nerve with manifestations of neuropathy, mostly in the productive population. Many conservative treatments have been observed to reduce the degree of pain and quality of life in CTS patients. Kinesiotaping is a new therapy that has been widely used for various musculoskeletal conditions and is known for reducing median nerve compression.

Aim: To determine the effect of adding kinesiotaping to median nerve gliding exercise on hand function in CTS patients by using the Michigan Hand Outcomes Questionnaire.

Methods: This research was an experimental randomized pre-and post-test group design. A sample of 24 patients from the Medical Rehabilitation Outpatient in RSUP Dr. Kariadi were divided into two groups randomly. The intervention group (n=12, dropout 1) got kinesiotaping application and median nerve gliding exercise. The control group (n=12, dropout 1) did the median nerve gliding exercise only. Hand performance has been evaluated before and at the end of the 4^th week of treatment by using the Michigan Hand Outcomes Questionnaire.

Result: There were significant improvements in the intervention group’s right-hand function (p<0,001), activities of daily living (ADLs) or the ability of the right hand to do certain tasks (p<0,001), work performance (p<0,001), pain (p=0,024), and satisfaction (p<0,001), as compared to the control group. Meanwhile, the intervention and the control group did not show significant differences in left-hand function score (p=0.884), left-hand ability score (p=0.884), and aesthetics score (p=1,000).

Conclusion: There was a positive effect on improving hand performance in CTS patients by adding kinesiotaping to median nerve gliding exercises.

The Effects of Additional Radial Shock Wave Therapy on Spasticity of Upper Extremity Muscle

Go Linda Sugiarto — 2023-08-28

Background: Spasticity is one of the most common problems and greatly interferes with the functional capacity of chronic stroke patients. The most commonly used treatments are infrared therapy and stretching exercises, but they have not reduced spasticity effectively. The addition of Radial Shock Wave Therapy (RSWT) was expected to be more effective in reducing spasticity in chronic stroke patients.

Aim: The purpose of this study is to prove that the addition of RSWT is more effective reducing spasticity of chronic stroke patients.

Material and methods: This study was a simple randomized controlled pre- and post-experimental design. The total sample of 30 chronic spastic stroke patients with the Modified Asworth Scale 2-3 was divided into 2 groups: the study group and the control group. RSWT was provided once a week to the muscle belly of the flexor wist muscle on the ventral aspect of the forearm, the intrinsic muscle of the hand, and flexor digitorum tendon. They were added to infrared therapy and stretching exercises in the upper extremities which are provided three times a week for six weeks consecutively. The level of spasticity was measured by the Tardieu Scale, which measures quality and angle of resistance at the beginning and end of the study.

Results: A significantly greater reduction was obtained (p<0.05) from the level of spasticity measured by the Tardieu Scale, both on the quality and angle of resistance, in the study group.

Conclusion: The addition of RSWT has been shown to have a greater reduction in spasticity in upper extremity muscle in chronic stroke patients.

The Effect of Topical Gel Ethanol Extract of Gotu Kola Leaf (Centella Asiatica (L.) Urban) on Wound Healing in a White Male Rat (Rattus Norvegicus) Induced by Streptozotocin

I Dewa Ayu Sudiari Dewi — 2023-08-28

Background: Diabetes mellitus (DM) can have a number of consequences, one of which is diabetic neuropathy, which can cause sores, notably in patients' feet. Wound therapy with synthetic drugs in diabetes is still not functioning as well as expected. Centella Asiatica (L.) Urban has been demonstrated to promote wound healing through a variety of mechanisms, including collagen synthesis stimulation, fibroblast proliferation stimulation, antiulcer, antibacterial, and antioxidant activity. Pharmaceutical treatments for wound healing are routinely utilized upon the assumption that a moist wound is a gel.

Aims: The purpose of this study was to see how a topical gel ethanol extract of gotu kola (Centella Asiatica (L.) Urban) promoted wound healing in streptozotocin (STZ)-induced white male rats (Rattus Norvegicus).

Methods: This is an experimental study using twenty white male rats (Rattus Norvegicus) caused by STZ. The rats were placed into four groups, each with five rats. These four groups are the control group, the treatment group P1 (ethanol gel gotu kola leaf at 2.5% concentration), the treatment group P2 (ethanol gel gotu kola leaf at 5% concentration), and the treatment group P3 (ethanol gel gotu kola leaf at 10% concentration). STZ was used to promote blood sugar elevation in the rats. The wound healing rate was estimated by comparing the wound healing rates of each group using macroscopic observation.

Result: The findings of this study revealed that extract gel gotu kola leaf concentration applied to the wound on days 4, 7, 11, and 14 has a statistically significant influence on wound healing (p=0.000).

Conclusion: Based on the research conducted, it can be concluded that gotu kola extract gel has a significant influence on the rats’ wound healing.

Cardiopulmonary Resuscitation Management for Sudden Cardiac Arrest on Field Sport Activity

Arni Kusuma Dewi — 2023-08-28

Background: Sudden cardiac arrest (SCA) is the most common cause of sudden death in athletes, accounting for 75% of all deaths during activity and sports. In order to preserve athletes' lives, cardiopulmonary resuscitation (CPR) and on-site defibrillation with an Automated external defibrillator (AED) should be undertaken immediately. Thus, observers ought not to hesitate in performing cardiac compression to restore circulation.

Aim: to increase the number of coaches or teams commencing CPR and so improve the opportunities of survival after sudden cardiac arrest.

Material and Methods: By collecting a total of ten studies, this article implements a literature review methodology to evaluate CPR administration in occurrences of SCA among field athletes. CPR administration, on-field sports, SCA, and athletes as subjects are the study's main objectives.

Results: In accordance with the study's results, administering AEDs earlier is more effective. The majority of cardiac arrests in the field aren't treated immediately and accurately, which leads to fatalities. Because a cardiac arrest occurring during the first 10 minutes is critical for the athlete's survival, each minute lowers the athlete's chances of surviving by 7-10%.

Conclusion: SCA in athletes is a serious medical condition that frequently results in death. To save athletes' lives, CPR and on-site defibrillation using an AED must be performed immediately.