Author: admin

Heera vijayakumar¹, Diker Dev Joshi²

Author:

²Lecturer, Padmashree Institute of Physiotherapy, Bangalore, Karnataka, India

Corresponding Author:¹Professor, Padmashree Institute of Physiotherapy, Bangalore, Karnataka, India, Mail id: heerapt1977@gmail.com

ABSTRACT

Introduction: A case of 48 year old female patient with multiple fractures atright shoulder, chest and Pelvis was admitted in BGS Global hospital Kengeri, Bangalore. The patient met with an accident in which a tractor passed though half of her body leading to multiple fractures. As most of the fractures were turned out to be stable the patient was given painkillers and calcium tablets and started physiotherapy after 1 week. Methodology: Physiotherapy was started with Ankle Toe Movements, ROM exercise, sponge ball exercise, Incentive spirometry, Trunk rotation exercises, and gentle massage on the injured areas. The patient was given gait training in later stage followed by exercises in walker. Pre and post assessment taken for muscle power of shoulder and hip, Visual Analogue Scale for body pain and Functional Independent Measures to find the outcome. Result: After 8 weeks of daily physiotherapy, the patient improved with muscle power, reduced body pain, improved body function and the patient started walking without any assistive devices. Conclusion: With immediate physiotherapy even with multiple fractures the patients can get back to their Activities of Daily Living. Keywords: Fracture Rehabilitation, Muscle Power,  Visual Analogue Scale, Functional Independent Measures, Activities of Daily Living,

Received on 15th August 2020, Revised on 28th August  2020, Accepted on 31st  August 2020, DOI:10.36678/IJMAES.2020.V06I03.006

INTRODUCTION  

A 48 year old female patient named Niveditha who was housewife by profession presented with pain on pubis and upper back region along with right shoulder and right area of chest. History of present illness showed that on 6^th December 2018, patient went to pond to immerse a god idol after a prayer when a tractor passed through half of her body. She was immediately shifted to BGS global hospital Kengeri, Bangalore, where X ray was taken and it was found that she had multiple fractures of ribs, pelvis, neck of femur and both pubic rami. Along with that she had also sustained injury on the spine of scapula. But all the fractures were found to be stable. Her shoulder was immobilized in a sling for a week whereas, for remaining fractures painkillers and calcium tablets were advised by Orthopedician¹. She was then started on physiotherapy protocol.

METHODOLOGY

Before the physiotherapy treatment pre values were taken for Pain using VAS scale, MMT for muscle power of shoulder and hip and functional Independence through Functional Independence measure ^2,3,4.  Physiotherapy was started with ankle toe movements⁵, limited Range of Motion exercises for right upper and lower limbs and full ROM exercises for left upper and lower limbs⁶. Patient was advised for bed rest to prevent pressure sores and she was kept in air Bed⁷. For the fingers, patient was given a sponge ball and was advised to squeeze it at least 3 times a day (1 set of 10 repetitions each time) ⁸. As patient was depressed she was given psychological counselling⁹. The patient had mild pleural effusion for which she was given incentive spirometry (1 set of 10 repetitions each time) twice a day¹⁰.

On 3^rd week the repeat X ray was taken on which it was seen that fractures were not healed completely. The shoulder sling was removed and trunk rotation exercises were started carefully with 15 degrees of spinal rotation¹¹.  

On 4^th week, patient’s preparation for sitting was started. Initially patient was bought to inclined position by placing 2 pillows over her entire back to avoid the postural hypotension, which could have occurred had the patient been brought to 90° supine lying directly. The numbers of pillows were weekly increased to increase the inclination. By 8^th week patient was made to sit 90°.After that the patient was slowly brought to long sitting¹².

Once long sitting was achieved, high sitting training was started¹³. Then sitting to standing practice was started for the patient with the support from the physiotherapist¹⁴.Once the patient was comfortable in standing position she was made to stand for more time with the help of walker and it was followed by walking few steps with the help of walker¹⁵.Slowly the patient could walk herself with the help of walker.

On 8^th week, a repeat X ray was done which showed healed fractures. The patient was then taught weight lifting and weight bearing exercises¹⁶. The patient started walking without any walking aids. At this stage the post outcome measures scores were taken [Table 1] which showed good improvement. Patient was already off the medications except calcium tablets and she was not taking even painkillers. The patient was than taught home exercises and regular physiotherapy was stopped.

Ethical Clearance: Ethical clearance has obtained from BGS Global hospital Kengeri, Bangalore to conduct this study.

Conflict of interest: There was no conflict of interest to conduct this study.

Fund for the study: It was aself financed study.

CONCLUSION

Early physiotherapy intervention is quite helpful for improving the functional independence of patient even in multiple fracture case. ROM exercises, Bed Mobility, Trunk rotation exercises, functional reeducation along with psychological counselling can help  a great deal to make the patient independent.

REFERENCES

1. Wraighte PJ, Scammell BE. (2006 Jun). Principles of fracture healing. Surgery (Oxford). 1; 24(6):198-207.
2. Bergh I, Sjöström B, Odén A, Steen B. (2001 Oct 1). Assessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales. Aging Clinical and Experimental Research, 13(5):355-61.
3. Aitken DM, Bohannon R W. (2001 Mar 1). Functional independence measure versus short form-36: relative responsiveness and validity. International Journal of Rehabilitation Research, 24(1): 65-8.
4. Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1; 67(12):1867-72.
5. Hickey BA, Cleves A, Alikhan R, Pugh N, Nokes L, Perera A. (2017 Sep 1). The effect of active toe movement (AToM) on calf pump function and deep vein thrombosis in patients with acute foot and ankle trauma treated with cast–A prospective randomized study. Foot and Ankle Surgery, 23(3):183-8.
6. Kisner CA, Colby LA. (2012). Range of motion Therapeutic exercise foundations and Techniques, 61-73.
7. Biggie J, et al. (1999 Jul). Air distribution device for the prevention and the treatment of decubitus ulcers and pressure sores. United States patent US, 5; 926; 884.
8. Magnus CR, et al. (2013 Jul 1). Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Archives of physical medicine and rehabilitation, 94(7); 1247-55.
9. Cuijpers P, van Straten A, van Schaik A, Andersson G. (2009 Feb 1). Psychological treatment of depression in primary care: a meta-analysis. British journal of general practice., 59 (559); e51-60.
10. Overend TJ, et al. (2001 Sep 1). The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest; 120(3):971-8.
11. Yamauchi T.(2015 Jun 1). The effect of trunk rotation during shoulder exercises on the activity of the scapular muscle and scapular kinematics. Journal of Shoulder and Elbow Surgery; 24(6):955-64.
12. Ladozhskaya-gapeenko EE, et al. (2018 Jul 3). Method for treating and preventing diseases having neurological, cardiological and therapeutic profiles. United States patent US, 10; 10; 469.
13. Arry RH. (2004 Nov). The interactional management of patients’ physical incompetence: a conversation analytic study of physiotherapy interactions. Sociology of Health & Illness. 26(7):976-1007.
14. Hoppenfeld S, Murthy VL, editors. Treatment and rehabilitation of fractures. Lippincott Williams & Wilkins; 2000.
15. Härdi I, Bridenbaugh SA, Gschwind YJ, Kressig RW. (2014 Apr 1). The effect of three different types of walking aids on spatio-temporal gait parameters in community-dwelling older adults. Aging clinical and experimental research, 26(2); 221-8.
16. Yung P, Lai YM, Tung PY, Tsui HT, Wong CK, Hung VW, Qin L. (2005 Aug 1).  Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound. British journal of sports medicine, 39(8):547-51.

Citation: Heera vijayakumar, Diker Dev Joshi (2020).Rehabilitation of a patient with multiple fractures caused by tractor running over half of body: A case Report, ijmaes; 6 (3); 825-828.

Jibi Paul¹, T.Bhuvaneswari²

Author:

²B.P.T. Graduate, Faculty of Physiotherapy, Dr.MGR. Educational and Research Institute, Deemed to be University, Chennai, Tamilnadu, India

Corresponding Author:

¹Pofessor, Faculty of Physiotherapy, Dr.MGR. Educational and Research Institute, Deemed to be University, Chennai, Tamilnadu, India Mail id: physiojibi@gmail.com

ABSTRACT

Background of the study: Overweight is more body fat than optimally healthy individuals, overweight is common where food supplies are plentiful and life style is sedentary. Plyometric is designed to enhance muscular power and explosiveness. The word aerobic meaning exercise with oxygen, high intensity aerobic exercise can help on control weight and reduce stress. Objective of the study was to find the effect of plyometric exercise and high intensity aerobic exercise and also to compare the effect between the exercises among overweight college students. Methodology: This was a comparative study with quasi experimental design. The subjects were divided into two equal groups, 15 samples in Group A and Group B by convenient sample method. Group A received high intensity aerobics like jogging, burpees, mountain climber exercise, squat with side step, wall push ups, where Group B received plyometric exercises like squat jack, skater jump, jumping side lunge, rock star jump and high knees. Both exercises were given for three sessions in a week. Inclusion criteria include BMI of 25-30 and above, both male and female college students of aged 18-23 years. The measurement tool used was Body Mass Index and Waist Circumference. Result: The result showed a decrease in BMI and waist circumference in both the groups. But the weight reduction was more in Group A when compared to the Group B with p >0.000. Conclusion: The study concluded that high intensity aerobic exercise decreases the BMI and waist circumference effectively among overweight college students when compared to the plyometric exercises. Keywords: Plyometric, High intensity aerobic exercise, Waist circumference, Body Mass Index

Received on 15th August 2020, Revised on 27th August  2020, Accepted on 31st  August 2020, DOI:10.36678/IJMAES.2020.V06I03.005

INTRODUCTION  

Overweight is having more body fat than is optimally healthy individuals. The definition of overweight in adults has variations over time. Obesity and overweight constitute an important public health problem because of associated increase risk of hypertension, coronary heart disease, type 2 diabetes, stroke, gall bladder disease, certain type of cancer, osteoarthritis, sleep apnoea and other disorders. Overweight range is calculated according to the body mass index (BMI), where BMI >25 ^{1, 2}.

High intensity aerobics will help to control weight and reduce stress by conditioning the heart and lungs with the help of oxygen ⁽⁴⁾. High intensity aerobics will help to relax the tensed muscles and regular practice of aerobics will increase the production of endorphins (a natural sedative) and catecholamine (chemical substance which stabilize the mood). So, long term aerobic exercise is considered to be reasonable and effective to reduce weight. Some scholars suggest that high intensive exercise of 85% VO2 max with appropriate positive rest in short time is more effective to lose weight ^{3, 4, 5}.

Plyometric is a type of training were muscles undergo a rapid elongation followed by immediate shortening (stretch-shortening contraction) utilizing the elastic energy stored during stretching phase ⁷. Plyometric training is a fantastic cardio work out and a great way to burn the calories. So, it is an effective work out supplement to lose weight. In fact muscle stronger and improve endurance capabilities. It enhances the metabolism and helps to burn calories. Indeed, this exercise will facilitate weight loss ^{6, 7}.

Both high intensity aerobics and plyometric are meant for burning calories by increasing metabolism. So, it is considered as an important component to reduce overweight. Body mass index (BMI) is a simple and widely used method for estimating body fat mass. Belgian statistician developed BMI in 19^th century ^(4). BMI is not only used classify obesity and overweight but also to find out life expectancy and prevalence of overweight and obesity related issues and co morbidities ^8,9,10

METHODOLOGY

This was a comparative study with quasi experimental design. The subjects were divided into two equal groups, 15 samples in Group A and Group B by convenient sample method. All samples were selected for the study from the ACS medical college and hospital, Chennai. Group A received high intensity aerobics like jogging, burpees, mountain climber exercise, squat with side step, wall push ups, where Group B received plyometric exercises like squat jack, skater jump, jumping side lunge, rock star jump and high knees. Both exercises were given for three sessions in a week. Inclusion criteria include BMI of 25-30 and above, both male and female college students of aged 18-23 years. The measurement tool used was Body Mass Index and Waist Circumference. The study was conducted for duration of 3 months. Subjects with hypertension, any cardio vascular disease, any depressions, chronic renal failure, smoking status, history of diabetes, any history of recent fracture were excluded from the study. 

Procedure: According to the BMI reading of over (26-30) is considered as overweight and the BMI was calculated from the following equation BMI(in kg m2)=Body mass(in kg)/Height 2 (in m).Thirty college students were selected from the ACS medical college and hospital, in the age group of 18-23 years selected conveniently .The selected 30 subjects were provided with the informed consent after obtaining proper consent the selected  and subjects were divided into two equal groups of fifteen each namely high intensity aerobic exercise was given to group A(15 subjects) and plyometric exercise was given to group B(15 subjects).Overweight was tested before(pre) and  after(post) the training program for both experimental  groups by using Waist circumference and conventional method was used to measure BMI, weight, height of each subjects was measured using a wall stadiometer, WHR, body fat percentage%(4).The obtained values were recorded. According to the protocol, the exercises had been given for Group A (High Intensity Aerobic Exercise) and Group B (Plyometric Exercise) followed by three months, the BMI and Waist circumference was again measured and the obtained values are recorded.

Exercise Intervention

The selected subjects had undergone plyometric and high intensity aerobics thrice a week which have been in practice. Before the training they had undergone warm up for 5 minutes and cool down for 5 minutes. The group A has been engaged with High intensity aerobics of Jogging, Burpees, Mountain climbers, Squat with side sitting, Wall push up, the group B has been engaged with an Squat jack, Skater jump, Jumping side lunge, Rock star jump, High knees. Each exercise consists of 5 reputations in high interval of 30 seconds practice and low interval of 10 seconds of resting period.

Group A (High Intensity Aerobic Exercises)

Jogging: Jogging is running at a gentle pace. It is as running slower than 6 miles per hour (10 km/h).Jogging will have a wider lateral spacing of foot strikes, creating side- to-side movement that likely adds stability at slower speeds or when coordination is lacking.

Burpees: Burpees or squat thrust is a full body exercise used in strength training. The basic movement is performed in four steps and known as a” four-count burpees.”

Method: Begin in a standing position. Move into a squat position with your hands on the ground (count-1). Kick your feedback into a plank position, while keeping your arms extended (count 2). Immediately return your feet into squat position (count 3). Stand up from the squat position (count 4).

Mountain Climber Exercise: Mountain climbers are a great total body exercise in which you are going to utilize your entire core because it is started in plank position.

 The shoulders should stabilize your upper body. The triceps muscle should work isometrically to keep you in place.

Squat With Side Step: Side step and squat. Stand with your feet together. With your right foot take a wide step out to the right and squat down. As you straighten the legs, step your right foot back in. repeat on the left side.

Wall Push Ups: Face the wall, standing a little farther than arm’s length away, feet- shoulder width apart. Lean your body forward and put your palms flat against the wall at shoulder height and shoulder width apart.

Group B  (Plyometric Exercises)

Squat Jack: Squat is a compound, full body exercise that trains primarily the muscles of the thigh, hips and buttocks, quadriceps femoris muscle( vastus lateralis, vastus medialis, vastus intermedius and rectus femoris),hamstrings as well as strengthening the bones, ligaments and insertion of the tendons throughout the lower body.

Skater Jump: It is landing in one foot without touching the other one down and at the same time you can touch the ground with each jump so to make this a little bit easier you can touch your foot down on each sides alternatively.

Jumping Side Lunge: Stand on your left leg with your hips and knees slightly bent extend your left hip, knees and ankle to jump forward and to the right at a 45-degree angle land on the ball of your right foot with your hips and knees slightly bent to absorb the impact immediately jump off your right leg in the opposite direction.

Rock Star Jump: Also called as side-straddle hop in the US military, is a physical jumping exercise performed by jumping to a position with the legs spread wide and the hands touching overhead, sometimes in a clap, and then returning to a position with the feet together and the arm at the sides.

High Knees: Skip in place by hopping on your right leg while bringing the left knee up towards your chest. Engage your abs as the knee comes towards your chest. Switch legs, and keep skipping while pumping your arms. This completes one reputation.   

Data analysis and interpretation

The above table reveals the mean, standard deviation(S.D),T- test, degree of freedom (DF) and P values of the BMI between (Group A) and (Group B) in pre-test and post- test.

This table shows that there is no significant difference in the pre-test values of the BMI between Group A and Group B (^*P>0.05). This table shows that statistically significant difference in the post test values of the BMI between group A and group B (^**-P≤0.01).

The above table reveals the mean ,standard  deviation (S.D),T-test, degree of freedom(DF) and P-values of the waist circumference between (group A) and (group B) in pre-test and post-test.

This table shows that there is no significant difference in pre-test values of the waist circumference between group A and group B (^*P>0.05). This table shows that statistically significant difference in post-test values of the waist circumference group A and group B (^**-P≤0.01)

The above table reveals the mean, standard deviation (SD),t-values and P-values of the BMI between pre-test and post-test within group A and  group B.

In BMI there is a statistically highly significant difference in the pre-test and posttest values within group A and group B. (^**-P≤0.01)

The above table reveals the mean, standard deviation (SD), t-value and p-value of the waist circumference between pre-test and post-test within group A and group B.

In waist circumference there is a statistically significant difference between the pre-test and post-test values within group A and group B (*-P≤0.01).

RESULT

Pre and Post-test values within Group A and B, it shows a statistically significant difference in the BMI where P value is 0.000*. And also in pre and post-test values within Group A and B, it reveals significant difference on Waist Circumference where P value is 0.000*.

On comparing between the Group A and B found significant difference of P value 0.000*.  BMI found significant mean difference of 2.75 (27.24-24.49) and 0.78 (27.40-26.62) respectively.   Waist Circumference also found significant difference with mean difference of 29.74 (95.40-65.66), 16.54 (100.80-84.26) respectively. 

DISCUSSION

Based on the selection criteria 30 subjects with overweight of 25 to 30 were participated in the study. The purpose of this study was to compare the effect of plyometric versus high intensity aerobics among overweight college students.

Aerobic exercise has significant improvement on waist circumference than plyometric exercises. Outcome measures used for this study were Body Mass Index and waist circumference ¹¹.

Plyometric burns the maximum amount of calories in the shortest amount of time while toning the body from head to toe, reported the importance of Plyometric exercise in fitness. Plyometric exercises to a High intensity interval training program may be more beneficial than only High intensity interval training in obese female adolescents ^{12, 13}.

Training at high intensity is superior to improve cardiopulmonary fitness and to reduce % body fat in adults with obesity compared to traditional exercises. Another issue is the motivation for an exercise program in person with overweight depression; a negative body image and embarrassment are factors that can influence the decision to participate in an exercise program. Recent evidence suggests that HIIT can be a time-efficient strategy to promote health in sedentary overweight /obesity individuals ¹⁴.

In this review and Meta analysis, the effectiveness of high intensity training in terms of weight reduction was compared to plyometric forms of exercise in overweight college students. Based on the results on this Meta analysis we can conclude that training at high intensity aerobic is a better method to reduce overweight than plyometric¹⁵.

In this study the values of BMI and waist circumference in centimetres of pre-test and post-test were compared by the mean difference. When the inter group mean values of BMI were analysed, in Group A mean for BMI pre-test and post test was BMI 27.24 and 24.49 respectively. The mean values of Group B for pre test and post test was 27.40 and 26.62 respectively from the data analysis. The result shows that the reduction in body weight is more in Group A (High intensity aerobic exercise) compare to Group B (plyometric exercise).

When the inter group mean values of waist circumstance was analysed, Group A pre test mean waist circumstance 96.40 and post test mean waist circumstance 65.66 .The mean values of group B pre test mean waist circumstance 100.80 and post test mean 84.26 from the data analysis it shows that there was reduction in the waist circumstance in group A (High intensity aerobic exercise).

Ethical Clearance: Ethical clearance has obtained from Faculty of Physiotherapy, DR.MGR. Educational and Research Institute, Chennai to conduct this study with reference number: A–033/ PHSIO/IRB/2017-18dated 07/01/2018.

Conflict of interest: There was no conflict of interest to conduct this study.

Fund for the study: It was aself financed study.

CONCLUSION

This study concludes that the high intensity aerobics has considerable effect in reducing the weight among overweight college students. Therefore the HIAE is considered to be more effective than plyometric exercise program.

High Intensity Aerobic Exercise can effectuate weight reduction in a shorter period of time, but also mechanisms like increased post exercise fat oxidation and a decreased post exercise appetite could play a role.

Training at high intensity is superior to improper cardio pulmonary fitness and to reduce body fat percentage in adults with overweight compared to plyometric exercise.

REFERENCES

1. Young-Han Park, PhD and Jung-Ho lee, PhD: (2017).The effects of abdominal interferential current therapy on waist circumference and visceral fat distance in obese women., J.Phys Ther.Sci ; 29; 1680-1683.
2. A Febin jebaraj, Dr C Robert Alexander (2016). Effect of plyometric and aerobic exercise on obesity among school students. International journal of physical education, sports and health,  3 (2); 83-85.
3. Liye zheng (2016). Influence of aerobic it intensive training on obese college students. Biomedical research, 279 (2); 392-395.
4. Derrick cetin (2016). Comprehensive evaluation for obesity: Beyond Body mass index., J Am Osteopath Assoc., 116(6); 376-382.
5. Racil, Ghazi Etal (2015). Plyometric exercise combined with high intensity interval training improves metabolic abnormalities in young obese female more so than interval training alone. Canadian science publishing apnm -0384, R2.
6. Alberto Carvalho, Paulo Maurao and Eduardo Abade (2014). Effect of strength training combined with specific plyometric exercise on body composition, vertical jump height and lower limb strength development in elite male hand ball players: a case study, Journal of human kinetics volume. 41; 125-132.
7. Su Reid- St. John (2015). Blast fat with plyometric. Make your body a jiggle –free zone with these fun fat blasting moves. (4); 4422-4438.
8. KwonHR. Kim HR (2014). Effect of aerobics exercise on abdominal fat, thigh muscle mass and muscle strength, Korean diabetes, 34; 23-31.
9. Sousa NMendes R., et al (2013). Long –term effects of aerobic training versus combined aerobic and resistance training in modifying cardiovascular disease risk factors in healthy elderly men., Geriatr Gerontol Int; 13; 928-935. 
10. Coquart J.B., lemaire, et al (2010). Intermittent versus continuous exercise: effects of perceptually lower exercise in obese women. Med.Sci.Sports.Exercise.40 (8);1546-1553.
11. Raquel patricia ataide lime et al (2015). BMI, overweight status and Obesity adjusted by various factors in all age groups in the population of a city in northern Brazil. P: 914-271. 4141/ F: 914- 827- 5308.
12. Harris (2009). Effect of school based physical activity interventions on body mass index in children, a meta-analysis, 31,180(7); 719-26.
13. Baker LB, Lang JA, Kanney WL (2009). Change in body mass accurately and reliably predicts change in body water after endurance exercise. Eur J Appl Physiol; 105; 959-967.
14. Gan SK, Thompson W (2003). Changes in aerobic capacity and visceral fat. Diabetes care, 26; 1706-13.
15. Owens S, Gutin Allison Riggs Ferguson M, et al (1999). Effect of aerobic training on total and visceral fat in obese children’s., Medicine and science in sports and exercise, 31(1); 143-148.

Citation: Jibi Paul, T.Bhuvaneswari (2020).Plyometric versus high intensity aerobic exercise among over weight college students, ijmaes; 6 (3); 811-824.

Purnima Singh¹, Panomootil Blessy Varghese²

Author:

² Student M.P.T Neurology, Hosmat College of Physiotherapy, RGUHS University, Bangalore, Karnataka, India

Corresponding Author:

¹Principal of Hosmat college of Physiotherapy, RGUHS U niversity, Bangalore, Karnataka, India Mail id:  purnimasingh29@gmail.com

ABSTRACT

Introduction: Parkinson’s disease is a major concern when the disease progresses to the middle stage of the illness. The typical features of Idiopathic Parkinson’s disease (IPD) are tremors impairment of the muscle tone, involuntary movement and bradykinesia. Improvement in strength and balance of IPD patients has improved their mobility functions. Especially, balancing exercises on uneven surfaces with eyes open and closed help them in gaining confidence to move outdoor independently with lesser risk of fall. Methodology: A total numbers of 30 subjects were considered for the study. All participants underwent two sets of measurement. Pre-test which was done at the beginning of the study & the post-test which was done at the end of 3 & 6 months of the study. 30 patients effectively completed the set of balancing and strengthening exercises with eyes closed & open for the period of 6 months.   Results: All the subjects showed significant changes in BBS & ABC scales after 6 months of strength and balance training programs. The mean value of the pre- test scores were BBS – 37.23 ± 10.7 ABC – 57 ± 13.62 and post – test scores were BBS – 44.30 ± 8.78 ABC – 71.17 ± 13.62. Conclusion:  From the statistical analysis it is evident that strengthening and balancing training program on uneven surfaces are effective in reducing the risk of fall and increasing the confidence of mobility in patients with PD. keywords:  Parkinson’s disease; strengthening exercises; Therabands; balancing exercises.

Received on 15th August 2020, Revised on 27th August  2020, Accepted on 31st  August 2020, DOI:10.36678/IJMAES.2020.V06I03.004

INTRODUCTION  

Idiopathic Parkinson’s disease [IPD] is a group of the conditions affecting the motor system hence also called as motor system disorder. This is resulted due to the loss of dopamine producing in the brain cells.

Characteristics of Parkinson’s disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks¹.

Most of the movement-related symptoms of IPD is considered as the second most common neurodegenerative disorders.² When the amount of dopamine is too low, communication between the substantia nigra and corpus striatum becomes ineffective, and movement becomes impaired; the greater the loss of dopamine, the worse the movement-related symptoms. Other cells in the brain also degenerate to some degree and may contribute to non-movement related symptoms of Parkinson’s disease.³

The cause of Parkinson’s disease is unknown but researchers speculate that both genetic and environmental factors are involved; some genes have been linked to the disease. Although it is well known that lack of dopamine causes the motor symptoms of Parkinson’s disease, it is not clear why the Dopamine-producing brain cells deteriorate.

Genetic and pathological studies have revealed that various dysfunctional cellular processes, inflammation, and stress can all contribute to cell damage. In addition, abnormal clumps called Lewy bodies, which contain the protein alpha-synuclein, are found in many brain cells of individuals with Parkinson’s disease. The function of these clumps in regards to Parkinson’s disease is not understood. In general, scientists suspect that Dopamine loss is due to a combination of genetic and environmental factors^{2, 3}.

Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others. 

The primary symptoms of Parkinson’s disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some people are more affected than others are. Studies have shown that by the time that primary symptoms appear, individuals with Parkinson’s disease will have lost 60% to 80% or more of the Dopamine-producing cells in the brain. Characteristic motor symptoms include⁴:

• Tremors: Trembling in fingers, hands, arms, feet, legs, jaw, or head. Usually tremors occur while resting, but not while involved in a task. Tremors may worsen when a person is excited, tired, or stressed.
• Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult.
• Bradykinesia: Slowness of voluntary movement. Over time, it may become difficult to initiate movement and to complete movement. Bradykinesia together with stiffness can also affect the facial muscles and result in an expressionless, “mask-like” appearance.
• Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls.
• Parkinsonian gait: Individuals with more progressive Parkinson’s disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing. It may become difficult to start walking and to make turns. Individuals may freeze in mid-stride and appear to fall forward while walking.⁴

While the main symptoms of Parkinson’s disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These secondary symptoms vary in severity, and not everyone with Parkinson’s will experience all of them, and may include. Anxiety, stress, confusion, memory loss or dementia, constipation, depression, difficulty in swallowing, excessive salivation, increased sweating, erectile dysfunction, skin problem, slowness of speech and monotone speech, incontinence of urinary or urgency for urination. ⁵

Several guidelines have been published to assist in the diagnosis of Parkinson’s disease. These include the Hoehn and Yahr scale and the Unified Parkinson’s Disease Rating Scale. Tests are used to measure mental capacity, behaviour, mood, daily living activities, and motor function. They can be very helpful in the initial diagnosis, to rule out other disorders, as well as in monitoring the progression of the disease to make therapeutic adjustments. Brain scans and other laboratory tests are also sometimes carried out, mostly to detect other disorders resembling Parkinson’s is disease.

The diagnosis of Parkinson’s disease is more likely if. At least two of the three major symptoms are present (tremor at rest, muscle rigidity, and slowness). The onset of symptoms started on one side of the body. Symptoms are not due to secondary causes such as medication or strokes in the area controlling movement. Symptoms are significantly improved with levodopa.

Researchers may disagree on the number of stages of Parkinson’s disease (range from 3-5 stages). However, they all agree the disease is a progressive disease with symptoms that usually occur in one stage may overlap or occur in another stage. The stage increase in number value for all stage naming systems reflects the increasing severity of the disease. The five stages used by the Parkinson’s Foundation are:

• Stage 1: mild symptoms (tremors and/or movement symptoms like swinging arm while walking) do not interfere with daily activities and occur on one side of the body.
• Stage 2: Symptoms worsen with walking problems and both sides of the body affected.
• Stage 3: Main symptoms worsen with loss of balance and slowness of movement.
• Stage 4: Severity of symptoms requires help; usually person cannot live alone.
• Stage 5: Caregiver needed for all activities; patient may not be able to stand or walk and may be bedridden and may also experience hallucinations and delusions.^5,6

Parkinson’s disease cannot be cured completely but the symptoms can be relieved with the use of various medication with carbidopa is usually given for the PD treatment, Carbidopa helps in delay of conversion of levodopa into dopamine. The nerve cells use levodopa for the production of dopamine and thus replenish the supply deficiency of the brain’s dopamine⁷.

Thus, levodopa is very helpful (at least ¾) of Parkinson’s cases. Not all Parkinson’s symptoms respond equally to this drug. Tremors don’t have much effect but bradykinesia and rigidity is remarkably reduced. Balance issues and other symptoms may not be alleviated at all. Anti-cholinergic have a great effect in controlling tremors and rigidity. Bromocriotine, Pramipexole and ropinirole, mimics the role of dopamine thus helping the neurons to use it as dopamine.⁸

An antiviral drug amantadine also helps in reducing the symptoms. In May 2006, FDA also approved the drug called Safinamide, which can be used for diminishing the experience of “off” periods or patients with increasing symptoms of PD. In some cases, surgery can also be done for the patients not responding well to drugs. Deep brain stimulation (DBS) is now approved by U.S FDA (Food and Drug administration) where an electrode is implanted in the brain and is connected to an electrical device called pulse generator which can be externally programmed.

 This process of stimulation reduces the need of drugs thus decreasing the involuntary movements call dyskinesia which is a common side effect of these drugs. This procedure of stimulation to brain also reduces tremors, slowness and gait disturbances. DBS requires careful programming in order to work correctly^{3, 8, 9}.

Fall is very common in PWP. Gait impairment, freezing of gait, cognition, loss of postural control is the common cause of falling. This is not easily managed by medications only

Frequent falls can cause loss of mobility, restriction in daily living activities, fractures and cost of treatment is increased ^{10, 11}.

Studies have shown that exercises can be useful in preventing falls in PwP (patients with Parkinson’s disease).

Physiotherapy along with drug therapy is the most commonly used procedure for PwP. However, the Cochrane reviews have supported this procedure with many randomized control trials ^{7, 8, 12}.

Many authors have suggested that balance impairment in PD and normal old age changes causes decrease in the muscle strength due to their sedentary lifestyle. It has been noted that strengthening and balancing rehabilitation programs have reduced the risk of falls, prevent dysfunction and dependency in the elderly ^{13, 20, 21}.

METHODOLOGY

Study design:  An Interventional Study

Study population: Subjects who are diagnosed with IPD by their Neurologist

Study setting: The study was conducted (testing & Intervention) at Outpatient department of Bethel Medical Mission HOSPITAL.

Study sample size A total of 30 patients

Sampling Method: Purposive sampling

 Study duration: 6 months

 Selection criteria

Inclusion criteria:

• Diagnosed with IPD by their neurologist
• Ambulatory and able to follow simple commands
• Patient with Unified Parkinson’s Disease Rating scale score of 35 and above
• Patient with a score of above 40% on the Activities Specific Balance Confidence Scale (ABC).
•  

Exclusion criteria:

• Suffering from unstable cardiovascular disease
• Uncontrolled chronic conditions that might interfere with the safety and conduct of the training and testing protocol.
• Patients participated earlier in balance and strengthening program

Outcome measures tools used for the study

• The Berg Balance Scale (BBS)
• The Activities-Specific Balance Confidence Scale (ABC)

Material used:  Data collection Sheets, Stop watch,15 ft Walk way, 4-inch Foam Pads, Thera bands, Chairs, Weight cuffs and Thera tubes.

 Methods: A total of 30 subjects fulfilling the selection criteria were included in the study after taking informed consent from each one of them. The Unified Parkinson’s Disease Rating Scale (UPDRS) Score is used for their eligibility.

The Unified Parkinson’s disease rating scale (UPDRS) has 4 sections

I-Mentation behaviour and mood

II- ADL activities

III- Motor examination

IV- Complication of therapy

Score – 0 to 147

Higher the score = Worst performance ^12,15.

Baseline evaluation of Balance was be done using The Berg Balance Scale (BBS) Score, The Activities-Specific Balance Confidence Scale (ABC).

All participants received the same Balancing intervention and Muscle strength intervention for 6 months.  Outcome measurements of Balance and Muscle strength were assessed using The Berg Balance Scale (BBS), The Activities-Specific Balance Confidence Scale (ABC) at the end of 3 months & 6 months^13,17.

Use of outcomes measures tools

All patients were evaluated at baseline and at the end of 3 months & 6 months of treatment period by the same examiner using Berg Balance Scale (BBS) 14 items (0-4 points per task higher score=best performance).

This scale evaluates balance during activities like sitting, standing and positional changes.

The Activities specific balance confidence scale (ABC) is the scale which examines patients perceived level of balance confidence while doing 16 activity of daily living rated from 0 to 100 each^{14, 16}.

Procedure for intervention

Balancing exercise s were given thrice a week and strengthening exercises were given on remaining 3 days a week.

Thus, the duration for balance training was 30 minutes and strength training was for 15 minutes. Frequency of training – 3 days a week each for 6 days.

Balance Intervention:

Balance exercise session lasted for 30 min and was conducted on 3 non- consecutive days, every week. Balance training programme include standard rehabilitation exercises for balancing. This training improved balance in older adults with PD^{15, 16, 20}.

Training was in 2 parts :

1.Standing on a 4-6-inch-thick foam pad with feet- shoulder width apart with eyes open and then eyes closed along with neck in neutral followed by neck extension for 20 sec. Repeated for 5 times.

2.Standing with feet – shoulder width apart without the foam pad with eyes open and then eyes closed along with neck in neutral followed by neck extension for 20 sec. Repeated for 5 times.

Muscle strengthening intervention:

Strengthening exercises were done with weight cuffs, TheraBand & Theratubes. All participants had undergone progressive strengthening of trunk, hip, knee, and ankle.

The training protocol used standard principle of rehabilitation of using concentric and eccentric muscles strength.

RESULTS

Primary analysis:

Pairwise comparisons were done for scores of BBS and ABCS using paired t-test.

Secondary analysis:

Correlation between Age and UPRSD was done using Karl Pearson’s correlation coefficient.

Comparison of change scores and UPRSD between gender was done using Independent t-test.

All analyses were done at 95% confidence interval using Statistical package for social sciences (SPSS version 22, Chicago, IL) for Windows software.

Tables and Graphs:

Correlation between age and UPRSD:  Weak negative correlation existed (-.123) which was not statistically significant (p=.518)

Comparison of UPRSD between Genders:

Comparison of BBS and ABCS change scores between Genders:

BBS change score between 3-months and 6-months was better amongst women than men, statistically significant at p=.046. All other change scores were not influenced by gender (p>.05).

DISCUSSION

The main aim of the study was to evaluate disease specific and balance related measure in the given population. The clinical scales used in the study are sensitive in the evaluation of the risk of fall in patients with Idiopathic Parkinson’s Disease. Cut-off scores of these scales are very useful in clinical practice as it provides detailed description about impaired functional activities and balance related activities & can also be used to evaluate treatment outcomes.

The present study shows that balance and strengthening exercises together help in reducing risk of fall and improves functional mobility in patients with Idiopathic Parkinson’s disease.

In the study BBS and ABC pre and post test scores were analysed. It has been noted than all of the participants improved in their BBS and ABC scores.

BBS change score between 3-months and 6-months was better amongst women than men, & statistically significant at p=.046. All other change scores were not influenced by gender (p>.05). Similar study was done in the year 2003 & 2015 where they studied the Effect of balance and resistance training using computerized dynamic posturography (sensory orientation test) SOT for balance and muscle strength in 15 patients with IPD. Authors concluded that balance and strength of muscles can be improved in patient with PD by training programmes of balance and high intensity resistance ^{12, 19}.

A systematic review study reported the evidence of resistance training on the strength and function in patients with PD. The study demonstrated that moderate intensity training for 2-3 times per week over 8-10 weeks can result in significant improvement in strength, balance and others motor symptoms in patients with early to moderate stage of PD^18,20,21.

Another randomized control trial of 210 patients with PD were divided into 3 groups and were educated for balance training movement strategy training and strength training programs. The study concluded that rehabilitation training reduces the risk of falls in patients of mild to moderate stage of PD ^{19, 20}

The present study results provide validation and best combination of outcome measures used in PD. With these scales risk of recurrent falls too can be determined. Although the patients performed well according to the scales, but an independent validation of sample is important in order to use into clinical practice.

Ethical clearance: The ethical approval was granted by the ethical committees of the Hosmat College of Physiotherapy, Bangalore.

Conflict of interest: There was no conflict of interest to conduct this study.

Fund for the study: It was self-financed study.

Limitations: Small sample size, smaller time period of study, Frequent follow up.

 Recommendations: Early stages of Parkinson’s and larger study size

CONCLUSION

The study result showed that Strengthening and balancing exercises have a great effect on patients with Parkinson’s disease. It delays the progress of the Disease and helps the patients to regain their confidence in mobility and become more active and independent. According to the statistical analysis female patients showed better response to the training as compared to the male patients.

REFERENCES

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2. Kalia L V. et al.(August 2015). Parkinson’s disease; 386(9996); 8; 96-912. PMID 25904081.
3. Sveinbjornsdottir. S (Oct 2016). Quit;”The clinical symptoms of Parkinson’s disease” ; Journal of Neurochemistry.139 Suppl 1; 318-324; Bibcode: 2006JNeur. 26.9606G.
4. Braak, H et al. (1998). Staging of brain pathology related to patients with Parkinson’s disease. C. An algorithm (decision tree) for the management of Parkinson’s disease. Neurology; 50 Suppl 3; S157.
5. Poewe W (December 2006). “The natural history of Parkinson’s disease”. Journal of Neurology. 253 Suppl 7 (Suppl 7); VII2–6.
6. Marchese R, Bove M, Abbruzzese G. (2003).Effect of cognitive and motor tasks on postural stability in Parkinson’s disease: a posturographic study. Mov Disord., 18; 652 658. 
7. Deane KHO, Jones D, Ellis-Hill C, Clarke CE, Playford ED, Ben-Shlomo Y. (2001). Physiotherapy for Parkinson’s disease: A comparison of techniques. Cochrane Database Syst Rev. : CD002815.
8. Deane KHO, Jones D, Playford ED, Ben-Shlomo Y, Clarke CE. (2001). (Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev. 3):CD002817.
9. Olanow CW, Koller WC. (1998). An algorithm (decision tree) for the management of Parkinson’s disease. Neurology, 50 Suppl 3; S157.
10. Chung CL, Thilarajah S2, Tan D3. (2016 Jan).  Effectiveness of resistance training on muscle strength and physical function in people with Parkinson’s disease: a systematic review and meta-analysis. Clin. Rehabil., 30(1); 11-23.
11. Morris ME, Menz HB, McGinley JL, Watts JJ, Huxham FE, Murphy AT, Danoudis ME, Iansek R. (2015 Sep). A Randomized Controlled Trial to Reduce Falls in People With Parkinson’s Disease.Neurorehabil Neural Repair. 29 (8); 777-85.
12. Conradsson D, Löfgren N, Nero H, Hagströmer M, Ståhle A, Lökk , Franzén E. (2015 Oct). The Effects of Highly Challenging Balance Training in Elderly With Parkinson’s Disease: A Randomized Controlled Trial. Neurorehabil Neural Repair., 29(9); 827-36.
13. Corcos DM, Robichaud JA, David FJ, Leurgans SE, Vaillancourt DE, Poon C, Rafferty MR, Kohrt WM, Comella CL.(2013 Aug). A two-year randomized controlled trial of progressive resistance exercise for Parkinson’s disease. Mov Disord. 28(9); 1230-40.
14. Olanow CW, Wunderle KB, Kieburtz K. (2011 May). Milestones in movement disorders clinical trials: advances and landmark studies.MovDisord.,26(6); 1003-14.
15. Glendinning DS1, Enoka RM. (1994 Jan).  Motor unit behavior in Parkinson’s disease. Phys Ther., 74(1); 61-70.
16. Smania N, Corato E, Tinazzi M, Stanzani C, Fiaschi A, Girardi P, Gandolfi M. (2010 Nov-Dec). Effect of balance training on postural instability in patients with idiopathic Parkinson’s disease. Neuro-rehabil Neural Repair.,24(9); 826-34.
17. Qutubuddin AA, Pegg PO, Cifu DX, Brown R, McNamee S, Carne W. (2005 Apr). Validating the Berg Balance Scale for patients with Parkinson’s disease: a key to rehabilitation evaluation.Arch Phys Med Rehabil., 86(4); 789-92.
18. Hirsch MA, Toole T, Maitland CG, Rider RA. (2003 Aug). The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease. Arch Phys Med Rehabil., 84(8); 1109-17.
19. Inkster LM1, Eng JJ, MacIntyre DL, Stoessl AJ. (2003 Feb). Leg muscle strength is reduced in Parkinson’s disease and relates to the ability to rise from a chair. MovDisord. 18(2); 157-62.
20. Scandalis , T , et al. (2001).Resistance Training and Gait function in patients with Parkinson’s disease. Am J Phys Med Rehabil. 80; 38.
21. Glendinning, D: (2001). A rationale for strength training in patients with Parkinson’s disease. Neurology report (now JNPT); 21; 132.

Citation:   Purnima Singh, Panomootil Blessy Varghese (2020).effects of balance training and strengthening exercises on individuals with idiopathic parkinson’s disease, ijmaes;  6 (3); 799-810.

Pushparaj Vijayakumar ¹*, Rajavel Varatharajan ², Jibi Paul³

Authors: 

²Faculty of Pharmacy, AIMST University, Semeling, 08100 Bedong, Kedah Darul Aman, Malaysia

³Professor,Faculty of Physiotherapy, DR.MGR.Educational and Research Institute, Deemed to be University, Velappanchavadi, Chennai, India

Corresponding Author:¹*Professor, Rajarajeswari College of Physiotherapy, Kambipura, Mysore Road, Bangalore, Karnataka, India, Mail id: vijayrrc@yahoo.com

ABSTRACT

Background and objectives: The Cricket is known as “the gentleman’s game” which places physical demand on the players. This demand creates lot of stress on muscles leading to injuries if they lack fitness. Star excursion balance training (SEBT) programme forms a core component of the training among young men cricket players in improving their agility. The less research evidence on 6 weeks of SEBT program has led to design this study to identify whether there is any effect on agility in enhancing the physical performance and prevent the occurrence of injuries among young men cricket players. Method: This was a comparative experimental study  conducted on thirty young men cricket players (n=30) of age group ranged between 18 and 22 years. They were randomly selected for two groups as star excursion balance training (SEBT), Group A and conventional exercises training (CET), Group B with fifteen (n=15) subjects in each group. The Group A underwent Star excursion balance training programme and the Group B underwent conventional exercises training programme. The training for both groups was administered for 6 weeks with three sessions per week. Result: The result shows that there is significant improvement with P<0.0001 in agility T test score on performance in Group A and significant improvements in Group B, with P<0.0290. Comparative study between the group shows significant difference between the groups with P<0.0001, with mean difference of 0.060 and -1.453 respectively on Group A and B. So  Group A is better than Group B.   Conclusion: Six weeks of star excursion balance training programme can be recommended for young men cricket players to improve the agility in enhancing their physical performance and preventing injuries.

Keywords: Star excursion balance training, Agility T Test, Agility, Young men cricket players.

Received on 14th August 2020, Revised on 24th August  2020, Accepted on 31st  August 2020, DOI:10.36678/IJMAES.2020.V06I03.003

INTRODUCTION  

Cricket is one of the popular and oldest non-contact bat and ball sport which engages the players in running, throwing and catching during bowling, fielding, wicket keeping and batting. This leads to overuse and impact injuries to the upper limb, lower limb, head and back¹. Cricket is one of the sports characterized by many of the basic and variable skills, which is played in several versions, such as long format and short format. The long format is played over for five consecutive days as test matches and the short format includes one day and 20-20 matches.

The demand on the players due to various formats of cricket sport causes physiological overload, which depends heavily on the player’s ability to move quickly and powerfully. This greater stress on the cricketers demands an extreme physical fitness, not only for the performance, but also to prevent injuries. These larger demands are the reflections of frequent touring for the test matches, one day matches and 20-20 matches per season. The sprinting and turning within the wickets , running-up and delivering the ball when fast bowling , causes rapid acceleration and deceleration load on the lower limb musculature^2,3. The cause of stress in cricket players is due to sudden starting and stopping nature of sprinting between the wickets, fast bowling and fielding which contributes to onset of fatigue in overtime, resulting with impact of negative performance and increase in the risk of injuries. These intermittent activity in cricketers during bowling, fielding and batting, places them on demand on the physiological and neuromuscular system^4,5.

The bat and ball sport led the players to, overuse and impact injuries , at various anatomical sites with the region most vulnerable to injury accounting with 44.9 % in the lower limb, followed by upper limb at 29.4%, the trunk at 20.0% and head and neck at 5.7%. The range of injuries in cricketers varied between 22.8 % to 50.0 % in lower limb among other anatomical sites of injuries^6,7.The functional testing of balance and proprioception, strength, range of motion and agility determines whether a patient is able to return to play following an ankle injury⁸.

Due to the complex skills and rules in cricket, the players require a good physical fitness, skills and efficient strategies for an effective motor task performance in maintaining the body positions during sudden location and directional changes in activities of acceleration and deceleration which demands good balance. This task performance of sudden acceleration and deceleration rapidly with good balance and the ability to change direction or body position rapidly and to proceed with another movement is the ability defined as “Agility”⁹. The agility is the ability of a player to change position in space or to change direction quickly and effectively. And it is thought to be a reinforcement of programming through neuromuscular conditioning and neural adaptation of muscle spindle, golgi tendon organ and joint Proprioceptors¹⁰. The agility is a complex ability depending on coordination, mobility of joint system, dynamic balance, strength and speed. The balance training is effective in improving static postural sway and dynamic balance through neuromuscular control and performance enhancement¹¹. This ability to enhance the maintenance or control of body positions while quickly changing the direction during a series of movements should improve “Agility”¹².

The injuries can be an adverse outcome of participation in sports and recreational activities. The impact of injuries during these activities is most associated with cricket players at a value of 242/ 1000 injuries among other sport players. And it is recommended for injury prevention program, aiming at team ball sports (Cricket, soccer and netball) because of their comparatively high rate of both, overall and significant injury¹³. 

Training with rapid stretching of a muscle (eccentric action) immediately followed by a concentric or shortening action of the same muscle produces more force than the force produced by a concentric action alonebecause of the stored elastic energy within the muscle^{14, 15}. The components of stopping, starting and changing direction in the training programs assists in developing agility^10,16,17.  Training the above components through Star Excursion Balance Training (SEBT) among young men cricket players may be effective in improving the agility by increasing the balance and control of body positions during movements by neuromuscular conditioning and neural adaptation of the Proprioceptors¹⁰. But there are less scientific evidences in proving its effect. Therefore the purpose of this study is to determine whether there is any effect of SEBT program for 6 weeks on Agility among young men cricket players.

METHODS

This was an experimental and comparative study. Young men cricket players between the age group of 18 to 22 years, who were undergoing professional cricket training volunteered to participate in this study from the cricket academy at Bangalore. They were screened for selection criteria to include in this study. A total of 30 participants who satisfied the inclusion criteria were incorporated for the study after explaining the procedure and obtaining the signed written consent form. This study was a randomized controlled trial and the selected subjects were randomly allocated into two groups by paper and chit system, Group A (N=15) the training group and Group B (N=15) the control group.

Inclusion criteria: Young men cricket players of age group between 18 – 22 years, participants with agility T score of more than 11.5 seconds, and subjects with stroke balance stand test score of more than 40 seconds.

Exclusion criteria: Subjects withany limb length discrepancy, spinal or lower limb deformities, history of surgery of spine or lower limb or upper limb, history of injury of spine or lower limb or upper limb, history of neurological dysfunction in the lower limb or upper limb, vestibular dysfunction and any visual impairment were excluded from the study.

Materials: Measuring tape, White athletic tape, Four (4) agility cones, Stop watch, Paper and pencil were the materials used to conduct this study.

Measurement tools:  Agility T test used to measure the performance of cricket players

Intervention:  Star excursion balance training (SEBT) and Conventional exercises training (CET).

Procedures:

This study was designed with a pre and post intervention randomized control trial. Those subjects in training group (Group A) received star excursion balance training (SEBT) programme, while the subject in control group (Group B) received conventional exercises training program. The subject in both the groups were permitted to continue their regular cricket practice, but were not permitted to start any other extremity strengthening and balance training program during this course of study. Rather, they were permitted to perform only the approved training program of this study.

The subjects in both the groups were instructed to come in shorts and barefoot, one week before commencement of the study. They were explained and demonstrated to learn about the variables which have to be executed in the study and were made to practice in a correct manner. The Agility T-test was used as an outcome measure for Agility. On day one of the study, subjects in both the groups underwent a baseline testing as a pretest score and then a posttest score was measured on the last day of 6^th week.

Dependent Variable Testing:

The agility T test is a reliable and valid measure for leg speed and secondarily of leg power and agility in lower limb²⁰. The outcome measure was measured using agility T test. Before starting the test, four cones were taken and arranged on the track in the shape of “T”. The four cones A, B, C, & D were arranged perpendicular in the shape of “T”. The cones A and B were arranged perpendicular to Cones C & D. The point between Cone A and B was arranged in 9.14 meters and the point of arrangement between Cone C and D from Cone B was 4.57 meters. After the arrangement of cones the subject was made to stand with both the feet behind the starting point (Cone A) facing towards Cone – B. Then on getting a start signal and by starting the stopwatch, the subject ran from Cone – A towards Cone – B and touched the base of cone – B with the right hand. After touching Cone –B the subject ran towards Cone – C and touched the base of Cone – C with the left hand. Then the subject shuffled towards Cone – D to touch its base with the right hand. After this moment the subject shuffled back towards Cone –B and touched its base with the left hand followed by running towards Cone – A to finish. After crossing Cone – A, immediately the stopwatch was stopped and the total duration of time taken to complete the run between the cones was documented.

Group A: Star Excursion Balance Training (SEBT) group:

Prior to starting of the training program, the preparation for Star Excursion Balance training was performed, initially by selecting a flat and non-slippery surface. Then Four (4) strips of white athletic tapes of 6 feet in length were cut. In order to form the star grid shape on the floor, two strip were pasted in the form of “+” and the other two strips pasted across on the top in the form of “x”. It has to be assured that the stripes pasted are arranged to each other from a center point at angle of 45 degrees with each other. This star shaped grid arrangement involves a series of single-leg squats with the stance limb and a dynamic maximal reach using the non-stance limb to touch a point as far as possible along eight designated lines radiating from a central point at an angle of 45°^18,19.

The subjects in the training group were informed to come in shorts and barefoot. To start with each training session the subjects were made to perform 3-minute of warm up followed by Star excursion balance training (SEBT) and conventional exercise training continued with 2-minute of cool down The warm up and cool down included dynamic movements and static stretches.

The subjects from the SEBT group performed the Star Excursion Balance training initially by standing in bilateral stance with barefoot on the middle of the star grid. The weight bearing leg is the stance limb and the unsupported leg is the reaching limb. Then the subjects were instructed to balance their body weight on the stance limb on the middle of the star grid where the strips of tapes are placed at an angle of 45 degrees. By keeping the hands on the pelvis, the subjects were made to reach a distance of 2 feet marked on the tape in all the 8 directional tape positions with the tip of toe of the reaching limb without shifting weight on the reaching limb. The 8 directional tape positions are anterior, anteromedial, medial, posteromedial, posterior, posterolateral, lateral, anterolateral. After each directional reach the subject returns the reaching limb to the start position at the middle of the grid, resuming a stable bilateral stance with 3 seconds of rest between each tape direction. The training with SEBT program was done with 12 rounds in clockwise and 12 rounds in counterclockwise reach. During each session, the subjects were given with a period of 30 seconds rest, to perform the same exercises by changing the stance limb and the reaching limb. The training was administered for 6 weeks with the frequency of three sessions per week.

Group B: Conventional Exercises Training (CET) group:

The subject in the conventional exercise training group performed the following exercises with 2 sets of 10 repetitions per day under the supervision. To start with each training session the subjects were made to perform 3-minute of warm up follow by Conventional Exercises Training (CET) continued with 2-minute of cool down. The warm up and cool down included dynamic movements and static stretches.

Two legs straight knees heel raise – Facing the wall: The subject was made to stand facing the wall with both knees in extended position. Both the feet’s were placed away by shoulder width and in front of a wall away by 6 inches with hands place on the wall at the level of the shoulder. The subject was instructed to raise the heel up on toes as high as possible and hold for a period of 10 seconds and relax for 10 seconds.

Two legs bent knees heel raise – Facing the wall: The subject was made to stand facing the wall with both knees in mild flexed position by placing the patella on the wall. Both the feet’s were placed away by shoulder width and in front of a wall away by 6 inches with hands place on the wall at the level of the shoulder. The subject was instructed to raise the heel up on toes as high as possible and hold for a period of 10 seconds and relax for 10 seconds.

Two legs straight knees heel raise- Facing away the wall: The subject was made to stand facing away from the wall with both knees in extended position. Both the feet’s were placed away by shoulder width and in front of a wall away by 12 inches. The subject was instructed to lean on the wall with the upper back and head supported and to raise the heel up on toes as high as possible while pushing the shoulder back into the wall and hold the heel raise for a period of 10 seconds and relax for 10 seconds.

Two legs bent knees heel raise- Facing away the wall: The subject was made to stand facing away from the wall with both knees in mild flexed position both the feet’s were placed away by shoulder width and in front of a wall away by 12 inches.  The subject was instructed to lean on the wall with the upper back and head supported and to raise the heel up on toes as high as possible while pushing the shoulder back into the wall and hold the heel raise for a period of 10 seconds and relax for 10 seconds.

One leg straight knee heel raise – Facing the wall: The subject was made to stand in unilateral stance facing the wall with the stance knee in extended position and foot in front of a wall away by 6 inches. Opposite foot is kept unsupported with hands place on the wall at the level of the shoulder. The subject was instructed to raise the stance heel up on toes as high as possible and hold for a period of 10 seconds and relax for 10 seconds.

One leg bent knees heel raise – Facing the wall: The subject was made to stand in unilateral stance facing the wall with the stance knee in mild flexed position by placing the patella on the wall and foot in front of a wall away by 6 inches. Opposite foot is kept unsupported with hands place on the wall at the level of the shoulder. The subject was instructed to raise the heel up on toes as high as possible and hold for a period of 10 seconds and relax for 10 seconds.

One leg straight knees heel raise- Facing away the wall: The subject was made to stand in unilateral stance facing away from the wall with the stance knee in extended position and feet in front of a wall away by 12 inches. Opposite foot is kept unsupported. The subject was instructed to lean on the wall with the upper back and head supported and to raise the heel up on toes as high as possible while pushing the shoulder back into the wall and hold the heel raise for a period of 10 seconds and relax for 10 seconds.

One leg bent knees heel raise- Facing away the wall: The subject was made to stand in unilateral stance facing away from the wall with the stance knee in mild flexed position and feet in front of a wall away by 12 inches. Opposite foot is kept unsupported. Lean on the wall with the upper back and head supported. The subject was instructed to lean on the wall with the upper back and head supported and to raise the heel up on toes as high as possible while pushing the shoulder back into the wall and hold the heel raise for a period of 10 seconds and relax for 10 seconds.

Forward and Reverse lunge: The subject was made to stand on the ground with your feet hip-width apart from each other. The both hands of the subject were on the side by holding 1kg dumbbells. Then the subject moved the left leg 1 foot forward simultaneously lowering the body until both the front and back legs comes to 90 degrees angle. Here it was instructed that the left leg should not go in front of your toes and at the same time, and also the back leg should not bend down the floor to touch it. Hold this position for 2-3 seconds. Rise above and take your left leg back to complete one rep. Repeat the same with the Right leg. To perform reverse lunges the subject was made to take the foot backward and then bend both legs down to get into a 90 degree angle. Repeat the same with the opposite leg.

RESULTS

The results of this study were analyzed in terms of the total time taken to complete the agility “T” test as an outcome measure indicated by improvement of agility by the enhancement of physical performance and thereby preventing injuries through efficient leg power, balance and speed of activity in the lower limb. The comparison was done between pretest and posttest data.

A total of 30 young male cricket players with age group between 18 to 22 years were included into two groups of SEBT group and CET group with 15 subjects in each. So as to evaluate the effectiveness of agility under this present study, both the intra group and inter group analysis (Group A and Group B) was done among the subjects who underwent star excursion balance training programme (Group A) and conventional exercises programme (Group B).

Within group analysis the improvement in agility T test score value for Group A on agility has reduced with mean difference of 1.747, with significant difference of P value  > 0.0001, while in Group B agility has reduced with mean difference of 0.233, with significant difference of P value < 0.029.

In between group Comparison of Group A and Group B, it has shown no significant difference on the pre- test agility score value with mean difference of 0.06000 and P value of < 0.561. However there was high significant difference in the improvement of post-test agility score value on agility with mean difference of -1.453 and P value of < 0.0001.

The above table 3 shows no significant difference in the pre-test agility score on agility among subjects between Group A and B with P value < 0.5914.

The above table 4 shows statistically significant difference in the post-test agility score in the improvement of agility among subjects between Group A and B with P value < 0.0001.

DISCUSSION

This present study was conducted to compare the effects of star excursion balance training (SEBT) programme versus conventional exercises training programme, in improving agility among young men cricket players. Our current study demonstrated that star excursion balance training (SEBT) administered for 6 weeks with the frequency of three sessions per week has showed statistical significant result in SEBT group and CET group on agility. On comparison between the groups, there was no statistical significant difference between the pre-test score values of agility T test but there was significant difference in effectiveness on agility between the post test score values between the groups. Here it is demonstrated with more effective on the mean difference among the SEBT group when compare with the mean difference on CET group.

This agility T-test is a reliable test for agility which is stated by Pauole et al., (2000)²⁰ that, the agility T-test appears to be a reliable and valid measure of leg speed, leg power and agility which can be benefited as a field test to assess the lower extremity movement in ground based sports and discriminate between low and high levels of sport participation and also supported by Hermassi et al., (2011)²¹ concluded that total time of agility T-test is significantly associated with explosive muscular power of lower limbs, vertical jump performance and acceleration ability and its result suggest total time of agility T-test has an unique fitness quality to considered as field test that is relevant to be used in training prescription and talent identification.

Our data confirmed that there is improvement on the agility in the subjects of SEBT group through 6 weeks of star excursion balance training programme and less significant improvement on the agility with conventional exercise training programme as measured through Agility T test, which is similar to the previously reported finding by Rogers et al., (2012)²² stating that agility and perturbation are effective than resistance training to reduce and improve function postural control. The Inter group analysis of our study has shown with statistical significance, in improving the agility between the groups with more mean difference in SEBT group. This significant finding suggests that by performing star excursion balance training programme, there is associated contribution of training strength, training ability of balance, training ability of dynamic performance and training compressive loading over the joint in improving the functional performance with good Static and dynamic balance, efficient and quick change in direction of movement, skill to quickly stops and resume the movements which are the core components of agility.

The lesser improvement in agility among the subject in the conventional exercise training programme group may be due to less sensory input programme by dynamic loading on the limb while performing the conventional exercises. We therefore hypothesis that star excursion balance training (SEBT) programme is better than conventional exercises training programme (CET) and may contribute in improving agility among young men cricket players  for an efficient performance and prevention of injuries. Studies have adduced evidence by Rogers, Rogers, & Takeshima, 2005²³ who examined the effect of the ability to balance and stated that this effect of balance is entirely depended on sensory input and muscle strength .The sensory input occurs through visual, vestibular, and somatosensory systems. The visual system contributes to balance, by providing information about the environment, location, and the direction and speed of movement within the environment, whereas the vestibular system, give information about the position and movement of the head. The somatosensory system rules the position of the body and limb through information from receptors and muscle receptors and is similarly supported by Hasegawa et.al (2010)²⁴ stated that the mechanoreceptors respond to any compression or tension during of loading over the limb and the afferent impulse are carried from periphery to central nervous system via spinal level, were it generates motor activity for protective mechanism of the respective joint.

These findings are similar to the findings of Matthews P B (1982)²⁵ that proprioception is used for the regulation of total posture (postural equilibrium) and segmental posture (joint stability), as well as initiating several conscious peripheral sensations (“muscle senses”). This “muscle sense” sensations correspond to the contemporary terms joint position sense (posture of segment), kinesthesia (active and passive), and the sense of resistance or heaviness. Thus, proprioception correctly describes afferent information arising from internal peripheral areas of the body that contribute to postural control, joint stability, and several conscious sensations.

Furthermore, the statistical significance in star excursion balance training (SEBT) group on agility in our study could probably be due to the improvement in the components of postural control strategies. Indeed it has shown significant difference in improvement on agility among SEBT group rather than CET group.  Similarly, Chiung-Ling Chen (2014)²⁶ stated that, in the initial phase, rotational perturbation induced earlier ankle movement and in faster and larger vertical center of mass displacement, while translational and forward/toe up perturbations induced larger head and trunk angular change and faster and larger horizontal center of mass displacement. In the reversal phase, balance reaction was attained by multi-joint movements. Translational and forward/toe up perturbations that induced larger upper body instability evoked faster muscle activation as well as faster and larger hip or knee joint movements.

Balance training, the amplitude, velocity and direction of perturbations can be varied to practice in-place or stepping reaction and normal strategy used to respond to an external perturbation can be trained to the patients to offer visions for selecting appropriate support surface perturbations for assessment and for designing methods for training postural control. These findings are similar to findings by Ogaya (2011)²⁷that balance training in elderly people using wobble boards is effective to improve their standing balance by improving their standing time on a wobble board, on a balance mat, and maximum displacement distance of anterior-posterior center of pressure by which they frequently control their center of gravity and maintain a standing posture on unstable surface conditions. And the training on tilt board or uneven surfaces improves the ability to stabilize in an upright stance position. These postural exercises strategy restores body’s center of mass to stabilize through body movement centered primarily on the ankle joints and has significant impact on functional improvements in knee joint.

The result of this study was in compliance with the finding of the study conducted by Sporis et. al.,²⁸ stated that agility training can be used effectively as a training method for improving explosive leg power and dynamic athletic performance. Hence in addition to the well-known method of training such as resistance training and plyometric training, strength and conditioning, athletes may incorporate agility training as well into an overall conditioning programme of athletes striving to achieve a high level of explosive leg power and dynamic performance. This is supported by Miller et al., 2006²⁹ that agility is the ability which makes it possible for an athlete to change direction, make quick stops and perform fast, smooth, efficient and repetitive movements and similarly a study conducted by Mayhew, et al. (1989)³⁰ states that agility is highly dependent on coordination and movement control but apart from coordination there is a substantial number of factors that affect the level of agility such as mobility of joints, dynamic balance, power and flexibility, level of energy resources, strength, speed and optimal biomechanical structure of movement.

In an another study conducted by Islam (2004)³¹, analyzed the effect of an  exercise training program challenging the sensory and muscle systems in older adults on Static balance, dynamic balance, maximum excursion, and strength and concluded that there is significant improvement in balance, lower body strength and function. Boeer (2010)³² assessed the changes in balance capacities by recording the total center of pressure excursion with 1-legged stance on the oscillatory Posturomed platform after a 12-week sensory-motor training program for older adults with osteoarthritis and recommended that this training program improves balance abilities and reactions to sudden disturbances and displacements.

Ethical clearance: The ethical approval was granted by the ethical committees of the RRF cricket academy, Bangalore.

Conflict of interest: There was no conflict of interest to conduct this study.

Fund for the study: It was self-financed study.

CONCLUSION

The results of this study indicates that there is improvement on agility among young cricket players with Star excursion balance training (SEBT) program as assessed by the level of dynamic performance and functional tasks in different positions through agility T test. Ultimately, our study stresses the importance of improving the agility through efficient postural swaying strategies, rapid change of direction, explosive leg power, quick stopping and resuming smooth and repetitive movements.

Furthermore, this improvement in agility through SEBT can be a beneficial training programme in demanding the physiological and neuromuscular system among young men cricket players, in improving leg power, balance and speed in lower limb with the ability to sprint suddenly, quickly, powerfully and stop suddenly between the wickets with less impact on the risk of injuries. Therefore, conducting a planned SEBT programme can be recommended for cricket players to improve their agility for an efficient performance and less impact on the risk of injuries.

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Citation:   Pushparaj Vijayakumar, Rajavel Varatharajan, Jibi Paul (2020).  Effect of star excursion balance training program on agility among young men cricket players , ijmaes;  6 (3); 784-798.

E. Usha¹, S Hepsibah Sharmil^2*, R. Ruth Saranya³

Authors: 

¹MSc Nursing Candidate, College of Nursing, Dr. M.G.R Educational and Research Institute, ACS Medical College and Hospital Campus, Maduravoil, Chennai, Tamil Nadu, India

³Associate Professor, College of Nursing, Dr. M.G.R Educational and Research Institute, ACS Medical College and Hospital Campus, Maduravoil, Chennai, Tamil Nadu, India

Corresponding Author:

^2*Vice Principal & Research Scientist, College of Nursing, Dr. M.G.R Educational and Research Institute, ACS Medical College and Hospital Campus, Maduravoil, Chennai, Tamil Nadu, India Mail id: hepsibah.srs@drmgrdu.ac.in

ABSTRACT

Introduction: Practice of mothers is crucial to seek prompt medical attention especially for their under  five years of aged children and it reduces the mortality rate of the children with severe acute respiratory tract infection. The aim of this study was to determine health care seeking practice of the mothers and to analyze the factors influencing mothers choice in seeking care for there under five children. Methodology: A cross sectional study was conducted at A.C.S Medical College at the three associated community health centers in Nasarathpettai, Meppur, Meppurthangal located at in Chennai. 251 mothers of under five children participated in the study. Result: The study revealed that only 61.59% of children where promptly taken to the used to GP clinic for acute respiratory tract infection and 48.34% children were treated with home remedy, 29.14% used to take to general physician. It was found that 19.21% used old prescription given for the same child and 7.95% mothers seek over the counter drugs from medical shop. Conclusion: Practice of health seeking behavior for acute respiratory infection among mothers of under five years children cannot be under estimated. It is the responsibility of the nurses and other healthcare people to create understanding on the management of acute respiratory tract infection to reduce further hazardous complication related to acute respiratory tract infection.

Keywords: Under five children, acute respiratory infection, practice of mother, health care  

Received on 12th August 2020, Revised on 22nd August  2020, Accepted on 30th August 2020, DOI:10.36678/IJMAES.2020.V06I03.002

INTRODUCTION  

Acute respiratory infection (ARI) causes 20 % of the mortality among under five children¹. However, ARI can be preventable and the intensity of the infection can be reduced if prompt medical care is sorted. ARIs causes more death and disease prevalence in children of under five years. More studies are proving that burden of ARI is present in both urban and rural area there are affect the low class and high class children’s in equally.

In the world under five deaths due to acute respiratory infection is the fifth leading cause. Globally, about 2 to six million (16%) ARI deaths are occurring in under five children. In India 1, 58,176 under five children’s are dies in acute respiratory infection (NHFWS 2018). The medical team gives priority care for children affected with ARI especially under five children. Because most of them under five children died in ARI disease burden is high. In India the major morbidity and mortality of children under five years deaths is caused by Acute Respiratory Tract infection. In India children under five years death due to acute respiratory infection in the year of 2018 is 882,000 which is 37 per 1000 live births ^{2, 3}.

Acute respiratory infection is divided in to two category upper respiratory infection and lower respiratory infection. The upper respiratory indicates from the nose to larynx associated with the paranasal. The lower respiratory tract is at end of the upper respiratory to alveoli (trachea, bronchi, bronchioles and alveoli). Many studies have reported that appropriate care seeking behaviors is the is the best practice. Prompt care seeking behavior is reducing the 20% of the child death rates due to acute respiratory tract infection. The mother and other to give a proper time care that should be reduce the child mortality rate.     

Objectives of the Study : To assess the care seeking behaviour and practice of mothers for children with acute respiratory infection, also to associate the socio-demographic variables with mother’s care seeking behaviour  on under Five children with Acute Respiratory Infection 

METHODOLOGY AND METHODS

This was a community based cross– sectional study carried out in the three rural community health centers namely Nasarephpettai, Meppur and Meppurthangal which are affiliated to the tertiary level hospital at the local regions of Chennai in the state of Tamil Nadu, India. These Community health centers are located across 10 km radius away from ACS medical college. The community health centers affiliated to the tertiary level hospital are also located within 10 km between metropolitan regions of Chennai to rural land. The setting has been chosen on the basis of feasibility of adequate sample and cooperation. Population is the entire aggregation of cases which meet the designated set of criteria (Polit and Beck 2004).

The overall population of the total Nasarathaipettai population is 8409 under five children population 156. The Meppur and Meppurthangkal total population is 2182 under five children 83 the entire aggregation of cases which meet the designated set of criteria.

All the children, under five years of age belonging to the study area were included as study subjects. The mothers of the children were the respondents. Care was taken to ensure that the family of the particular under five was a permanent resident of the area and not a frequent migrant. Those who could not be contacted during the first visit were given two more visits. The research protocol was approved by the ethical committee at the ACS Medical College and Hospital and informed consent was obtained from each subject prior to inclusion in the study. A predesigned and pretested structured questionnaire was used to collect the data. The mothers were interviewed for detail information regarding socio-demographic details and acute illnesses especially ARI in last two weeks prior to the visit as these are the main contributors to child morbidity. The health care seeking behavior for such diseases including the place and person consulted for disease, the treatment availed, the money spent and the distance travelled were also enquired. Records were analyzed whenever available. Proportions and percentages were used for analysis.

Sample Size Calculation

4pq/L²   = 90 (+10 – 20%)

(Prevalence (6%), q= 1-p, L = allowable error (.05)

The Study sample comprised of 2512 under five mothers

Sampling Technique: Purposive sampling technique was used to select the sample

Selection Criteria: The Study includes mothers of less than five children; Mother’s who have already treated the acute respiratory infection for their children, Mother’s who are willing to participate and Mother’s who can speak and write Tamil and English.

Exclusion Criteria: Pilot study samples and children with other genetic problem and comorbidity. 

RESULT

The analysis is a process of organizing and synthesizing the data in such a way that the research questions can be answered and the hypotheses are tested. The analysis and interpretation of the data collected from 251 mothers of under five children to assess the care seeking behaivour of mothers of less than five children with acute respiratory infection. The data was organized, tabulated and analyzed according to the objectives. Data analysis begins with description that applies to the study in which the data are numerical with some concepts. Descriptive statistics allows the researcher to organize the data and to examine the quantum of information and inferential statistics is used to determine the relationship. 

Organization of the Data: Data organized under the following sections.

Section A:

Description of the demographic variables of mothers of under five children.

Section B:

Assessment of care seeking behaviour of mothers of less than five children with acute respiratory infection.

Section C:

Association of care seeking behaviour with selected demographic variables.

Section A:      

Description of the demographic variables of mothers of less than five children.

The table 1 shows that the demographic variable number of living children had shown statistically significant association with level of care seeking behaviour among mothers of under five children with ARI at p<0.01 level and the other demographic variables had not shown statistically significant association with level of care seeking behaviour among mothers of under five children with ARI.

The table 1 depicts that regarding age of the child, most of them 117(46.61%) were aged 1 year to 3 years, 105(41.83%) of children were aged 3 years to 5 years, 25(9.96%) were aged 1 month to 1 year and 4(1.50%) were aged less than 1 month. Considering the sex of the child, most of them 135(53.78%) were male and 116(46.22%) were female. With respect to mother’s age, most of them 186(74.10%) were in the age group of     21 – 30 years, 63(25.10%) were aged 31 – 40 years and 2(0.60%) were in the age group of less than 20 years. Regarding the order of the child, most of them 132(52.59%) were 1^st baby, 107(42.63%) were 2^nd born baby and 12(4.78%) were 3^rd born baby. With regard to number of living children, most of them 166(66.14%) had two living children, 57(22.71%) had one child and 28(11.16%) had three and above living children. Considering the religion, most of them 234(93.23%) were Hindus, 15(5.98%) were Christians and 2(0.80%) were Muslims.

Regarding the place of living, all 251(100%) were living in rural area. The total family income per month revealed that most of them 146(58.17%) had an income of 20000 -30000, 89(35.46%) had an income of 10000 and 16(6.37%) had an income of above 30000. With respect to family structure, 161(64.14%) were single parent family, 70(27.89%) belonged to nuclear family, 18(7.17%) belonged to extended family and 2(0.80%) belonged to joint family. With regard to mother’s education level, most of them 194(77.29%) had basic schooling, 33(13.15%) were graduates and 24(9.56%) were illiterates. Regarding the mothers occupation, most of them 239(95.22%) were housewives and 12(4.78%) were daily wages. Considering the culture, all 251(100%) belonged to Tamil culture. Preferred food choice revealed that most of them 239(95.22%) were non-vegetarian and 12(4.78%) were vegetarian. Regarding the awareness of ARI, most of them 193(76.89%) had the awareness of ARI and 58(23.11%) were not aware of ARI.

Considering the source of information, all 251(100%) received information through Health Worker. With respect to how often your child get’s ARI, most of them 182(72.51%) responded as less often (once in few month), 65(25.90%) responded as very often (every month) and 4(1.59%) responded as rarely (once a year). Regarding who takes care of ARI child, most of them 247(98.41%) responded as mother and 4(1.59%) responded as grandparent. Considering the foods (diet) given to the child during ARI, most of them 152(60.56%) had not at all given food, 70(27.89%) had given all fruits, 21(9.16%) had given fiber diet and only 6(2.39%) had given citrus fruits.

Section B: Assessment of care seeking behavior of mothers of under five children with acute respiratory infection.

The table 2 shows that with regard to source of ARI, most of them 89(35.46%) don’t know about the source of ARI, 59(23.51%) responded as direct contact, 41(16.33%) responded as oral, 32(12.75%) responded as Vector C, 20(7.97%) responded as formite and 10(3.98%) responded as droplet. Considering the reason for not seeking medical help for ARI, most of them 173*68.92%) not at all seek medical help for ARI, 75(29.88%) used to try with home remedy like ginger/ honey/steam inhalation and only 3(1.20%) has not considered ARI is not a serious disease. Regarding the food choice you commonly give for ARI child, most of them 142(56.57%) used to give vegetarian and non-vegetarian  food, 61 (24.50%)  used  to

give only vegetarian food, 44(17.53%) used to give milk only, 3(1.20%) used to give only non-vegetarian and only one (0.40%) used to give no mild food.

The table 3 depicts that most of them 209(80.5%) had fever / increased body temperature i.e., 34% of the total responses, 202(80.5%) had irritation which constitutes 32.9% of the total responses, 130(51.8%) has nasal congestion / blocked nose i.e., 21.2% of the total responses, 30(12%) had difficulty in breathing which constitutes 4.9% of the total responses, 28(11.2%) had not able to drink or breast feed i.e., 4.6% of the total responses and 15(6%) had difficulty in breathing i.e., 2.4% of the total responses.

The table 5 depicts that most of them 93(61.59%) used to take to the child specialist, 73(48.34%) used to try home remedy, 44(29.14%) used to take to general physician, 29(19.21%) used to follow old prescription of same child and 12(7.95%) used to take to medical shop. The table 3 depicts that most of them 209(80.5%) had fever / increased body temperature i.e., 34% of the total responses, 202(80.5%) had irritation which constitutes 32.9% of the total responses, 130(51.8%) has nasal congestion / blocked nose i.e., 21.2% of the total responses, 30(12%) had difficulty in breathing which constitutes 4.9% of the total responses, 28(11.2%) had not able to drink or breast feed i.e., 4.6% of the total responses and 15(6%) had difficulty in breathing i.e., 2.4% of the total responses.

The table 5 depicts that most of them 93(61.59%) used to take to the child specialist, 73(48.34%) used to try home remedy, 44(29.14%) used to take to general physician, 29(19.21%) used to follow old prescription of same child and 12(7.95%) used to take to medical shop. The table 6 shows that most of them 122(48.61%) had no effective health seeking behaviour, 66(26.29%) had taken prompt care and 63(25.10%) had taken delayed care.

The table 7 shows the binary logistic regression analysis to find out the association of demographic variables with health seeking behaviour. The table depicts that income had shown statistically significant association with health seeking behaviour with chi-square value of (c²=4.790, p=0.029)and with an odds of 1.764. This clearly infers that income influences 1.7 times the health seeking behaviour of mothers of under five children with ARI.

 The table depicts that awareness about ARI had shown statistically significant association with health seeking behaviour with chi-square value of (c²=4.940, p=0.026)and with an odds of 2.14. This clearly infers that awareness response of ‘Yes” influences 2.14 times the health seeking behaviour of mothers of under five children with ARI. The other demographic variables had not shown statistically significant association with health seeking behaviour of mothers of children with ARI.

DISCUSSION

Health seeking behavior for mothers for their child with ARI is vital. Various studies have shown that early health seeking prevents complications and equally reduces the rate of death. Studies from developing countries have reported that delay in seeking appropriate care and not seeking any care, contributes to the large number of child’s deaths⁴. Improving parents/caretakers health seeking behavior could contribute significantly to reducing child mortality in developing countries. The World Health Organization estimates that seeking prompt and appropriate care could reduce child’s deaths due to acute respiratory infections by 20%⁵. Early health seeking behavior for child’s acute health problem could reduce morbidity, short and long term complications of the child health problem, this is seen in the integrated management of childhood illness (IMCI) strategy, besides improving providers skills in managing childhood illness also aims to improve parents/caretakers health care seeking behavior. The health workers are trained to teach the mothers about danger signs and counsel them about need to seek care promptly if these signs occur⁶ .

 Epidemiologists and social scientist have devoted increasing attention to studying health-seeking behavior associated with the leading causes of child mortality, include respiratory infection. Health interview surveys conducted in different countries report varying results about the determinants of health seeking behavior during childhood illnesses (Thind & Cruz 2003). Various factors have been implicated as determinants of health seeking behavior of parents. Some studies have reported that care seeking behavior is predicted by house hold size, age and education of parents. Lack of access to health care due to high cost is perhaps the most common deterrent to optimal health care seeking in both rural and urban communities. Some studies have also shown that perceived illness severity, maternal recognition of certain signs and symptoms of childhood illness were critical factors determining health care seeking behavior⁷.

Mothers and Guardians as caretakers may also not seek for help or abstain from seeking care for their child health if they fail to recognize symptoms or do not consider them dangerous.  In addition, once a caretaker or parents has recognized illness and decide to seek care, house hold responsibilities and long distances to health units may still delay care seeking. When health care are sought, the quality of treatment or care received might not be adequate and may cause delay in subsequent seeking for the same health care. It is to this regards to reduce respiratory infection mortality, three crucial steps in management have been suggested by UNICEF⁸: recognize, seek and treat. These steps are equally important. Many child deaths could be averted if timely recognition of symptoms was followed by prompt care seeking at a place where accurate diagnosis would lead to administration of right drugs in correct doses⁹. 

In this present study the binary logistic regression analysis to find out the association of demographic variables with health seeking practice. The table depicts that income had shown statistically significant association with health seeking behaviour with chi-square value of (c²=4.790, p=0.029) and with an odds of 1.764. This clearly infers that income influences 1.7 times the health seeking behaviour of mothers of children under five years with ARI. The table depicts that awareness about ARI had shown statistically significant association with health seeking behaviour with chi-square value of (c²=4.940, p=0.026) and with an odds of 2.14. This clearly infers that awareness response of ‘Yes” influences 2.14 times the health seeking behaviour of mothers of under five children with ARI. The other demographic variables had not shown statistically significant association with health seeking behaviour of mothers of children with ARI. Infants (0–11 months) are more commonly cared by care takers rather than the parents and boys more than girls. Mothers below 35 years of age, who completed secondary education and those who marry at a young age, present with the good in terms of caring for their sick children. Mothers who received professional antenatal care have an advantage of bearing healthy children less prone to infections. Previous Studies found that maternal age has effect on care given to children in families in term of health. For rural residents, younger mothers aged between 15–34 years are said to be more active in seeking health care than for older mothers over 35 years of age. In urban residents, mothers less than 25 years old present with more health seeking behavior than those over 25 years of age. It is also reported that younger families are more exposed to media communications than older families due to a higher education level, which might contribute to broad information received on health issues leading to better health seeking behaviors by those young mothers. According to Mukandoli ¹⁰, young mothers and males were found to be associated with prolonged delay in seeking health care. Previous study also revealed that the health seeking behavior of a community determines how health services are used and in turn the health outcomes of populations.

Factors that determine health behavior may be physical, socio-economic, cultural or political. Indeed, the utilization of a health care system may depend on educational levels, economic factors, cultural beliefs and practices. Other factors include environmental conditions, socio-demographic factors, knowledge about the facilities, gender issues, political environment, and the health care system itself¹¹. However, it is observed that socioeconomic, socio-cultural and demographic factors are often ignored while formulating health policies or any schemes for providing health care facilities to people. As a result, new schemes for providing health care services could not achieve its goal. Thus, health seeking behaviour is directed by socioeconomic, socio-cultural, and demographic factors, influence the health behaviour. In addition, according to Okwaraji et al¹² in effect of geographical access to health facilities on child mortality in rural Rwanda: a community based cross sectional study, small sized families thought more about their children’s medical attention for respiratory infection in rural and urban residence as opposed to large families. Families with more than 4 children suffer more not only economically but also in regards to concentrated and time spent with their sick child. This reason was more pronounced with urban residences perhaps due to difference in average family members. In urban households average 3.7 persons compared to rural households with 4.9 persons.

Ethical clearance: The institution review committee of ACS Medical College and Hospital, DR MGR Educational and Research Institute, Chennai, has granted ethical clearance for the study with reference number 19/2019/IEC/ACSMCH dated 09/10/2019.

Conflict of interest: There was no conflict of interest to conduct this study.

Fund for the study: It was self-financed study.

CONCLUSION

The study concluded that most of them 93(61.59%) used to take to the child specialist, 73(48.34%) used to try home remedy, 44(29.14%) used to take to general physician, 29(19.21%) used to follow old prescription of same child and 12(7.95%) used to take to medical shop.

The results can help the health seeking behavior on acute respiratory infection among under five mothers understand various aspects of self-management and other health care personal managements of under-five mothers and follow up^{13, 14}. It is the responsibility of the nurses¹⁵ to create understanding on the management of acute respiratory tract infection of  to reduce further complication related to acute respiratory tract infection.

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Citation:  E. Usha, S Hepsibah Sharmil, R. Ruth Saranya (2020). Practice of mothers to seek medical attention for their children with acute respiratory infection, ijmaes;  6 (3); 770-783.