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Studies in 30 subjects which are involved in a trial investigating the effect of an intervention.

Title 

A STUDY TO CHECK EFFICACY OF TREADMILL INTERVENTION ON IMPROVING WALKING AMONG CHILDREN WITH DOWN SYNDROME”

Keywords 

TREADMILL, DOWN SYNDROME, WALKING

Word count <11000

<11000

Author/s 

Dr. Bhawna

Ethical approval- 

This research as done by me Ms. Bhawna (MPTpeadiatrics) In Partial Fulfillment of the Requirement for the Degree of MASTER OF PHYSIOTHERAPY [M.P.T] under RGUHS Karnataka.

Abstract

The study sought to evaluate the impact of Treadmill interventions to improve walking among Down syndrome subjects.
The study involved 30 patients with DS in the age group of 2-7 years fulfilling the inclusion criteria were selected during convenient sampling methods. Following their inclusion a consent form was obtain from each of them. The results were assessed by 10 Meter Walk Test. Tests were performed before and after completion of study. The study was conducted over period of 9 months.

Result:
The results showed highly significant improvement on walking in children with DS.

Background

Non- specific type of LBPis common in adolescent and is also a disabling condition as they grow. There are many techniques of physiotherapy as well as others associated therapy such as yoga etc…but there efficiency is unknown.
Pilates was proposed as the best treatment strategies to improve muscle strength and endurance along with flexibility, posture and balance in non-specific type of LBP in adolescent.

Objectives

1. To study the effects of Pilates on adolescent with LBP.
2. To study the effects of Pilates on muscle strength in adolescent with LBP.
3. To assess the effects of Pilates on muscle flexibility in adolescent with LBP.
4. To assess the effects of Pilates on posture in adolescent with LBP.
5. To assess the effects of Pilates on muscle endurance in adolescent with LBP.

Methods

Experimental study design (Pre test-Post test)

Study selection or eligibility criteria

• Informed consent.
• Age between 12-18yeras.
• Both genders.
• Suffering from back pain from last 2months.
• Back pain due to Hamstrings muscle tightness or abdominal muscle weakness.

Interventions

Two types of Pilates were used as intervention-

1. Teaser

• Lying flat on back.
• Feet on the floor, knees fully extended.
• Arms and hands along your side.
• Slowly lift both legs.
• Simultaneously lift chest, head, and both upper limbs.
• Return to normal position.
• Slowly breaths in as you lift your body and out as you return to the floor.
• Repeat 5-10 times.

2. Swimming

• Lying on prone position with arms stretched position.
• Feet on the floor, knees fully extended.
• Squeeze your inner thighs and heels together.
• Squeeze your butt and try to keep pressing your pubic bone down to the mat
• Raise your head and upper back, simultaneously right arm and left leg.
• Then switch arms and legs and begin swimming rhythm alternating arms and legs.
• Extending your body as much as possible.
• Repeat 5-10 times.
• Then come up to your resting position, pressing back to the rest position.

Measures and variables

• Pain: Visual analogue scale (VAS)
• Function and Disability: Modified Oswestry Low Back Pain Questionnaire (MOLBPDQ)
Both were highly reliable and valid questionnaire .

VAS and MODQ are the outcome measure used on all subjects to quantify the change in pain and function of back before the interventions and after the 4th week on all subjects.

Study appraisal and synthesis methods

SAMPLE DESIGN:

Stratified random sampling

SAMPLE SIZE:

30 subjects fulfilling the inclusion criteria

DURATION OF STUDY:

Duration of the study 9-12 months.

The data (total number 30, male-15,female-15) was analysed by Wilcoxon Signed Rank Test and Mann-Whitney Test. The results stated that there was decreasing in pain in vas and improvement in quality of life of the subjects following above interventions.
The further analysis of data had found that there was significant decrease in pain as well as and also there was significant improvement in quality of life of the participants. The study proved that Pilates program is effective in adolescent with LBP.

Results

The study was carried out using Pilates Teaser and Swimming exercises on the subjects with non-specific LBP. The total number of subjects was 30. All subjects were treated with both exercises.
LBP is more common in girls with increase age, and high and low level of activity during period of rapid growth literature published by Russell Jago.
In this study method of assessment was done through VAS and MODQ. It was used to assess overall function of back as its validity and reliability has already been established. MODQ includes all those activities where joint mechanisms of the lumber spine are relatively understood and therefor it is very easy to determine which task increase or decrease mechanical deformation.
The pain assessment was done by Visual Analogue Scale (VAS). In this study, subjects showed highly significant improvement in pain relief. This study also reveals that age is also a significant factor to pain relief.
MODQ was used to assess the improvement in all the functions. The subjects were assessed for the performance of daily living activities. After the interpretation it has been proved that subjects showed a significant improvement. This study also reveals that age is not a significant factor to the improvement in functions.
MODQ activities noted by this scale such as personal care, lifting, walking, sitting, standing, social life, sleeping, travelling and employment/ home making. All this showed a significant improvement in pre and post data except travelling which result as not significant to the interventions.
VAS and MODQ scores across baseline and post interventions showed a highly significant improvement statistically in their mean score.
When compare to gender interventions showed not significant result.
Improvement of pain and disability may also be due to improvement in strength and endurance of core musculature of lumbar spine. This helps decreasing in the stress and abdominal loads on the spine by demanding a proper Neuromuscular control and coordination which is essentials for maintenance of body mechanism and posture when it is required to carry a load and to perform common daily activities.
According to the study of RaminKordi et alon study Low Back Pain in Children and Adolescents: an Algorithmic Clinical Approach, and concluded that In children younger than 7 years and particularly in those younger than 3, as a rule, back pain should be alarming for a hidden underlying pathology until proven otherwise. Commonly LBP in children is non-specific and will be managed by simple conservative treatments in short term. However in some groups especially those involved in sport activities other reasons such as Spondylolysis and Spondylolisthesis need to be considered. The role of psychosocial factors in treatment of the children with back pain should never be forgotten particularly in teens with positive family history of anxiety14.

Karen Grimmer et al, also supported the prevalence of LBP in adolescent. In their study, a longitudinal study of LBP in Australian adolescent with an aim to track reports of LBP in adolescent each year over a five-year period (13-17 years). A significant increasing prevalence of LBP was reported for girls and boys. The odds of girls reporting in the final year study compared with the first year was 4.4 (95%) for boys 1.6(95%). New cases of girls LBP decreased consistently over the study (90% in 2000, 46.1 in 2001, 42.1 in 2002, and 33% in 2003). New boys cases decreased in second and third year (85% in 2000, 45% in 2001) then increased (45.8% in 2002, 63.6% in 2003)48.

Jones MA et al suggested about higher prevalence of LBP in school going children. They conducted a school based survey of recurrent non-specific LBP to estimate the prevalence and consequences in children from northwest England. A cross section sample of 500 (males-251, females-249) aged between 10-16 years participated in the study. They reported that the average lifetime prevalence of LBP was 40.2%44.

Pilates is a technique use to improve muscle strength and endurance as well as flexibility and to improve posture and balance.
The study suggested that Pilates exercise have shown significant improvement in non-specific LBP in adult, but the effectiveness of this treatment protocol in the adolescent population is still unknown. But there is lack of evidence suggesting effectiveness of Pilates in adolescent with LBP, so there is a need to find out the effectiveness of Pilates in adolescent with LBP.
EDWIN CHOON, et al (2011) supported the effects and usefulness of Pilates in LBP. They did a meta- analysis on effects of Pilates-Based Exercises on Pain and Disability in Individuals with Persistent Nonspecific Low Back Pain and they found Pilates-based exercises are superior to minimal intervention for pain relief. This is an exercise to reduce pain and disability for patients with persistent nonspecific low back pain.Pilates exercises are effective than minimal intervention or other exercise interventions to reduce disability related to chronic low back pain59.

Pilates also effective to improve flexibility and stability.SUREEPORN PHROMPAET et al (2011) studied on Effects of Pilates Training on lumbo-Pelvic Stability and Flexibility and their result suggested that Pilates can be used as an adjunctive exercise program to improve flexibility, enhance control-mobility of trunk and pelvic segments. They also suggested that The results of this study indicate the specificity of Pilate-based exercise as an appropriate volume to contribute to physiological benefits which occur after 4 weeks of training as follows:
1. Enhances lumbo-pelvic stability
2. Improves flexibility of lower back and legs
It may also help in preventing and attenuating the injury and dysfunction of musculoskeletal system18.
This study supports that Pilates can be used to enhance lumbo-pelvis stability as well as flexibility.
Pilates also improve strengthening of core muscles and helpful in activation of core muscles. Susan Sorosky recommended Pilates method would be beneficial for patients with LBP because it improves absolute core strength and moreover encourages proper activation patterns of core musculature60.
According to Lim et al (2011) Pilates-based exercise is superior to minimal intervention for pain. Pilates whether it is Mat or Equipment based, both are effective and beneficial in LBP.

The results of this study also showed highly significant values towards pain (VAS) and quality of life (MODQ).
The finding of this study is similar to the various studies done on Pilates in LBP on adolescent, that Pilates is superior to minimal intervention for pain. It is also improve muscle endurance, posture, balance, stability, and also facilitate breathing pattern.

Limitations/Discussion

• Study included only 30 subjects which is a small sample size. Larger study involving increased number of participant should be employed.
• Duration of study was short (4 weeks). Hence long duration intervention is necessary for better outcome measures.

Conclusion

The objective was to find out effectiveness of Pilates in adolescent with LBP. This study results showed that Pilates had significantly decreased pain and improved quality of life in adolescent.
Pilates produced highly significant improvement in reducing pain (VAS score) and improvement in function (MODQ score) at the 4th week when compared to baseline values in subject with non-specific type of LBP.
Based on the above discussion and conclusion, it has been proved that this study supports the alternate hypothesis.

Funding and Declerations

NO

Registration number

if appropriate

Author Biography

include a short biography for each author and a link to their profile in Physiopedia

References

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