physiotherapy, J u n e 1982, voI 38, n o 2 43 TR EA TM EN T NOTE: A MOBILISING TECHNIQUE FOR THE SYMPHYSIS PUBIS R. M I T C H E L L , M .C .S .P .* This is a n i n tr o d u c t io n to a mo bilisin g tec hn iq u e o f the symphysis pu bi s which has been used for so m e years now. The c o n d it i o n o f sub lu x ed symp hy sis pubi s can easily be foun d, using kinesiology, pa rti cul ar ly by be h av io u ra l kinesiology, (B .K.) with m a n u a l ' localisation. If not a c q u a in t e d with B.K. testing th en this a re a can be tested by pressure o ve r the su p e ri o r a n d a r c u a te p ub ic ligaments. T endern ess indicates ligament s tr a in a n d th at so m e degree of su bl u x a ti o n is present. The side which is “ d o w n ” has an a sso ci ate d hy pe rto ni c a n d tende r gracilis muscle. T h e s u p e r i o r pubis r a m u s on the affected side is m or e difficult to pa lp a t e a n d is often tender. Resisted hip flexion on the affected side is weakened, c o m p a r e d with the “ g o o d ” side. H yp e r t o n ic it y o f p so a s/ i li a cu s plus a b d o m i n a l muscle i mb al an ce is a c o m m o n finding. Pain relieved so far includes reca lcitra nt sciatica (often on the o p p o si t e side); low bac k pain; kn ee pain; “ pe rio d p a i n s ” a n d o t h e r gyn aecological pains. It has a lso been not ed that cervical s u b l u x a ti o n s at C l & 2 often a p p e a r re duced after pelvic a d ju s tm e n t, parti cul ar ly in y o u n g wom en . ♦Private P ra c tit io ne r, D u r b a n . Received 30 April 1982. T E C H N IQ U E T his is simple bu t on e s h o u l d be war e o f p u t ti n g t o o m uch pressure o n the pa tie n t o r y o u r o w n co nt a ct h a n d . S t a n d on the affected side o f the sup in e pa tie nt , facing to w a r d s the p a ti e n t a t a b o u t waist level. T he c o n ta c t h a n d is on the sa m e side as the p a t i e n t ’s affec ted side. Slide this h a n d u p the inside o f the p a t i e n t ’s thigh, p alm o n thigh, t h u m b to w a r d s the head . M ak e c o n ta ct between the distal p a r t o f the 2nd m et a ca r p al a n d the inferior aspect o f the pu bi c ramu s. T h is point m ay be ten de r, so a p p ly pres sur e gently in the direc tion o f the p a t i e n t ’s chin. Th is pres sur e needs to be app lie d steadily for at least h alf a m inu te so reinforce the co n ta ct h a n d wi th the o t h e r h a n d a r o u n d the wrist o f the co n ta ct ha nd . Be careful to a v o id digging the t h u m b into the p a t i e n t ’s groin o r lower a b d o m e n . W he n the m o v e m e n t is felt, m ai n t ai n pressu re until the m o ve m e n t ceases. S om e p a ti e n ts feel m o v em e n t a n d a lt e ra t io n o f p ain level, whilst ot her s ask if a n y th i n g is ha pp en in g . Test a f te r w a r d s for in creased hip flexor stre ng th, re d u ct io n o f gracilis tension a n d tende rness, plus a m o r e easily p alp ab le p u b ic ramus. T he liga ment s are usually less tender. This is not a onc e only a d ju s tm e n t as gra vity a n d jer k y m o ve m e n t plus the u su al a b d o m i n a l muscle we akness a ss oc ia te d with this p ro bl em all mitig ate against total success in one session. T h u s follow up with a p p r o p r i a t e exercises for h o m e m an a g e m e n t but no sit-ups or straight-leg raising exercises! R a th e r use aw are ne ss training, f o r ex ample, F e ld en k r a is o r A l e x a n d e r techniques. RESEARCH PROCEEDINGS OF A MEETING OF THE NATAL COASTAL BRANCH OF THE SOUTH AFRICAN SOCIETY OF PHYSIOTHERAPY HELD ON 15 MARCH 1982 I n t e r e s t in r e s e a r c h a n d i n v e s t i g a t i o n a m o n g the m em b e rs h ip o f the N a t a l C o a st al B r a n ch increased its m o m e n t u m in early 1980 follow ing a Br a nc h lecture on research a n d its imp lica tions for the ph ysi ot her ap ist . As a result o f this lec ture an inf or ma l g r o u p of members particularly inte res ted in research was formed. C o n t a c t with the g r o u p has been m ai n t a i n e d o n a pe rsonal basis a n d d es p ite the m an y difficulties as soc iated with research in bu sy ho spital a n d p ri vat e practices, a n u m b e r o f projects hav e been u n d e r ta k e n ; these cover a wide range o f subjects. As p a r t o f the B r a n ch p r o g r a m m e for 1982 the co m m itt e e decided th at o n e B r a n ch mee ting sh o u l d be d e v o te d to those mem be rs w h o were involved in va r io u s fo rm s o f research a n d investigations. This mee ting was held in M a r c h wh en details p e rta in in g to ten different pr ojects were presented. These incl uded c om p l e te d studies, as well as tr end s ar ising ou t o f o n go in g studies. In a d d it i o n , the f o r m at for several projects a b o u t to be c o m m e n c e d were pr esented. R E F L E X O L O G Y (M rs O . Ison) M r s Iso n is on e o f a small g r o u p o f t her ap ist s w ho have been usin g reflexology (zone t h er a p y) in their pr actice for several years. A l t h o u g h she has tr ea te d a c o n sid era ble n u m b e r o f cases by this m et h o d , o nl y one pati en t has been referred by a d o c t o r specifically for reflexology. As a c o n s e q u e n c e M r s I s o n u s u a l ly uses r e fl e x o lo g y in c o n ju n c t io n with c o n v e n t i o n a l ph y si o th er a py . How eve r, she was able to re p o rt on so m e o f the results o f reflexology o b t a i n e d with p a ti e nt s who ha d sh ow n little o r no i m p r o v e m e n t when tr ea te d w it h the usua l p h ys io th er a p eu ti c modalities. Positive resp on ses were fo u n d in a g r o u p o f ne urologically im p a i r ed pa tie n ts w hich in clu de d ce re br al -v as cu la r accident (C .V.A .), cere bral palsy a n d P a r k i n s o n ’s sy nd ro m e. I m p r o v e m e n t was largely a t t r i b u t e d to a re d u ct io n in muscle tone, t h o u g h in o n e case o f C .V .A. there was som e re tu r n o f R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 44 Fisioterapie, Ju n ie 1982, dee! 38, n r 2 speech which h a d been ab sen t for a n u m b e r o f years. In the case o f one child with cerebral palsy there was a p r o n o u n c e d im p r o v e m e n t in swal lo win g as well as a general r e du ctio n in muscle tone. Several cases o f Bell’s palsy sh ow ed ra pid im p r o ve m en t. O f not e were tw o cases, one c om pl ica ted by shingles a n d the o t h e r with visual a n d a u d it o r y im pa ir me n t. In a child with a deficiency o f p i tu it ar y fu nc tion, there was a m a r k e d increase in a p p et ite a n d en ergy fol low ing tr ea tm e n t by reflexology, t h o u g h n o increase in g r o w t h was noted. Sinusitis a p p e a r s to re sp o n d p a rti cu la rly well, an average o f fo u r sessions o f reflexology being necessary. R e s p i r a t o r y t r a c t c o n d i t i o n s a s s o c i a t e d w i t h b r o n c h o s p a s m also sh ow ed i m p r o ve m en t. This was a tt r i b u te d to the re la xa ti on which o c cu r re d a fte r reflexology. Mrs Ison r e p o r t e d o n a p a tie n t w h o h a d been referred for tr ea tm e n t o f facial pain. T h e p a tie nt also h a d “ p o c ke ti ng o f the g u m s ” , a c o n d it i o n c h ara cte ris ed by i n f la m m a tio n, infection a n d recession of the gums. T h e c o n d it i o n cleared co mp le tel y a fte r seven tr e a tm e n ts using reflexology. In he r co nc lu sio ns Mrs Iso n r e m a r k e d th a t reflexology a n d p h y s i o t h e r a p y a p p e a r to w or k well when used togeth er b u t when reflexology h a d been used o n its ow n results were often dra m a tic . C H E S T P H Y S IO T H E R A P Y F O R N EO N A T A L R E S P I­ RATORY D IS T R E S S S Y N D R O M E (M r P. G ounden) Th is rep ort pr es en te d the findings o f a c o m p a r a t i v e study o f tw o m e t h o d s o f chest ph y si o th er a py used in the m an a g e m e n t o f n e o n a t a l re sp ir at o ry distress synd ro me s. M r G o u n d e n c o m p a r e d the m e t h o d devised by d o c to r s in 1966 a n d used since th en in King E d w a r d V I 11 Ho sp ita l, D u rb a n , with a revised m et h o d . Bl ood gas analysis was c arr ied ou t by using a t r a n s c u t a n e o u s oxygen m on ito r. This rep ort is p re sen te d in detail elsewhere in this issue. E F F E C T S O F EARLY P H Y S IO T H E R A P Y O N PA TIE N T S W IT H STAB W O U N D S T O T H E C H E S T (M rs H . Jenkins) T hi s was a re p o rt o f a s t u d e n t project c ar ri ed o u t in 1981. T h e subjects were A fr ica n male p ati en ts with ages rang ing fr om 16-50 years. All the pa tie nt s h a d p e n e t r a t i n g injuries to t h e c h e s t r e s u l t i n g in u n i l a t e r a l h a e m o ' t h o r a x , p n e u m o t h o r a x o r h a e m o p n e u m o t h o r a x . Pa tients were di vided into two gr ou p s (A a n d B). Both g r o u p s received the sa m e p h y s io th er a p y regimen bu t the time o f c o m m e n c e m e n t differed. G r o u p A consisted o f p a tie n ts s t a b b e d o n Fr i d a y evenings w ho c o m m e n ce d ph y si o t h e r a p y as s o o n as possible after inse rtion o f the inter cost al dr a in . G r o u p B c on sis ted o f pa tie nt s s t a b be d on S a t u r d a y nights w ho c o m m e n c e d p h y s i o t h e r a p y on the following M o n d a y mor ning s. B o th g r o u p s received the sam e p h y s i o t h e ra p y regimen which was given twice a day , each session lasting a p p ro x im a t e ly 30-45 minutes. E x a m i n a t io n o f results with five p a r a m e t e r s consistently sh o w ed th at early p hy si o t h e r a p y is beneficial to patients with s t a b b e d chests. L u n g f un c tio n tests ind ica ted the value o f ph y si o t h er a p y in b o t h gr o u ps . H o w ev e r , it was fo u n d that the pa tie n ts in g r o u p A sh o w ed g r e at er im p r o v e m e n t than th os e in g r o u p B a n d h a d be tte r p e r f o r m a n c e o n discharge. In g r o u p A the aver ag e d u r a t i o n o f intercostal dr a in a g e was 1,52 day s a n d in g r o u p B 2,6 days. Th er e was a difference in the avera ge n u m b e r o f days o f h o sp i t al i sa ti o n for each g r o u p . G r o u p A pa tie nt s were hos pital ise d for an average of 2,31 day s a n d g r o u p B pa tie nt s for 4 , 7 7 days. T he incidence of pyrexia a bo ve 37,2° C was 100 p e r c e n t in g r o u p B patie nts a n d h a lf this in g r o u p A. R e so lu tio n o f the h a e m o t h o r a x , p n e u m o t h o r a x o r h a e m o p n e u m o t h o r a x was noted. Twenty per cent o f patie nts in g r o u p A h a d a small residual h a e m o t h o r a x , c o m p a r e d with 60 pe r cent in g r o u p B. Tw o pa tie n ts in the l att er g r o u p r e qu ire d a sp i r a t i o n o f the h a e m o t h o r a x before discharge. S H O R T WAVE D IA T H E R M Y IN T H E T R EA T M EN T O F P E L V IC IN F L A M M A T O R Y D IS E A S E (M iss R. M uthialu) T h is was also a re p o rt o f a s t u d e nt project c arr ied o u t in 1981. A s t u d y was c o n d u c t e d to a sc ert ain w h e th er pa tie n ts with acu te on ch ronic pelvic in fla m m a to ry disease ( P. l.D .) treated with d r ug s a n d sh or t- w a v e d i a t h e rm y ( S . W . D . ) show q u i c k e r im p r o v e m e n t th an pati en ts tr ea te d with dr ug s only. Pa tie nt s are d ia g no s ed as h a vin g a cu t e on c hr o n ic P.l.D. when their c o n d it i o n is passing from an ac u te in to a chro nic state. A ft e r b ein g e x a m i n e d a n d d i ag n o s ed by a gynaecologist, 12 female patie nts were referred to the D e p a r t m e n t ofl Physical Medicine. T he pati en ts were then r a nd o m ly all o c at ed to 2 g r o up s (A a n d B), each g r o u p cons is tin g o f 6 patients. Pat ients w ho h a d P .l .D . asso ci ate d with o th er c o n d iti o n s such as u r i n a r y tract infection or peritonitis, an d p a ti e n ts w ho ha d su rg er y f o r the pelvic i n f la m m a to r y c o n d iti o n, were not in cluded in the study. Patie nt s in g r o u p A received d r u g th er a p y alone, consis tin g o f analgesics a n d an tibiotics. In ad d it i o n to the d ru g th er a p y , pa tie n ts in g r o u p B received S. W .D . This was given by the “ cross-fire” m e t h o d , the intensity being a m in im al per cep tib le heating. Pa tients were tr ea te d onc e daily at the s a m e time each day. On the first day t r e a tm e n t was a d m i n i st e r e d for 3 min ut es each way a n d the time was in creased by 1 m in u t e until a 10 m in u t e each way tr ea tm e nt per io d was reached. T hi s tr ea tm e n t was then c o n ti n u e d until two weeks h a d elapsed. Indices used to j ud g e r es ol uti on were pa in r a ti n g (using a num eric al ra ti n g scale), the degree o f a b d o m i n a l di stension a n d vaginal discharge. All o f these were assessed before the respective t r e a tm e n ts were c o mm en ced . Patie nt s in b o t h g r o u p s were ex am in ed by the gy naecologist at the end o f the first week a n d again at the end o f the se c o n d week. As sessments o f pain , a b d o m i n a l distens ion a n d vaginal disc har ge were carri ed ou t similarly. Re sults o b t a i n e d after 2 weeks s h ow ed th at in g r o u p A 5ft per cen t o f the pa tie n ts were painfree, there was a mean' r e d u c t io n in a b d o m i n a l dist ens ion o f 0.42 cen ti me tre s a n d a cle ara nc e o f vaginal disc har ge in 50 pe r cent. In g r o u p B these figures were 66 percent, 1,83 cen timetres a n d 83 percent respectively. Degrees of re sol uti on were assessed as: no re spo nse ( g r o u p A = 33,6%, g r o u p B = 16,6%), pa rtial respon se ( g r o u p A = 50%, G r o u p B = 16,6%) a n d co m p le te respon se ( g r o u p A = 16,6%, g r o u p B = 66.6%). D u e t o the small n u m b e r o f pa tie n ts in this stu dy , d a ta were no t subje cted t o statistical analysis. How eve r, it w ou ld a p p e a r th at the individual p r e se n ti ng clinical features, that is pain, a b d o m i n a l d i ste ns ion a n d vaginal discharge, im p ro v ed m o r e in the pa tie n ts tr ea te d wi th S. W .D . in a d d it i o n to drugs. Also, the rate o f r es ol uti on o f the P .l .D . o c c u r r e d over a s h o r t e r pe rio d o f time in these patients. M Y O F A S C IA L PA IN D Y S F U N C T IO N S Y N D R O M E (M r R. M itchell) M r Mit chell gave an interim re p or t on his w o rk on myofascial pain d y sf un c tio n s y n d r o m e ( M . P . D . S .) as ap pl ie d to the bite m ec han ism . T h is w o r k has been carried o u t in c o n ju n c t io n with a dentist for o ve r three years. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) p h ysio th erap y, Ju n e 1982, vol 38, no 2 45 He first de scribed and d e m o n s t r a t e d one o f the behavi our al kinesiology (B.K.) tests he uses in his practice. These tests m ay be used to assess the physical, m ental an d emo tion al welfare o f patients. T h e d e m o n s t r a t i o n show ed how muscles or muscle g r o u p s can test “ S t r o n g ” u nd e r some cir cums tances a n d the sa m e muscles can test “ W e a k ” u nd e r ot h er circ um st anc es , pa rticularly when related to stressful situations. Mr Mitchell uses B.K. testing in the asse ssmen t o f his patients with M . P . D . S . Recent research, m uch o f which has or iginated in the Unit ed States o f Am e ric a, has indicated that a wide ra nge o f sy m p t o m s a n d pa in sy n dr om e s are associated with a faulty o r u n b a la n c e d bite mechanism. Some o f these are: heada che s: dizziness: syncope; loss o f balance: neck, s h o u l d e r a nd a r m pains; low back pain; thoracic pain a n d sp as m ; h i p / l e g pain a n d stiffness, an d some anxiety states. As m any p ati en ts with these s y m p t o m s are sent f o r ph ys io th er a py , Mr Mitchell co n ten d s that e x a m in at io n o f the wh ol e o f the bo dy st ru c tu re including the -bite m echanism is necessary to give clues to the source o f the t r o u b l e , pa rti cu la rly in cases which have not r e sp o nd ed to the m or e usual forms of th erapy. Results o b t ai n e d from patients in w ho m a d ju s tm e n ts to the bite m ech an ism h a d been made, were discussed. If the assessment a s d e s c r i b e d shows a possible M . P . lJ.S. then M r Mitchell make s te m p o r a r y a d ju s tm e n ts to the p a t i e n t ’s bite using d e nt a l wax placed between the m olars on bo t h sides, each stage being assessed by B.K. testing as well as the pa ti e n t ’s rep ort o f pa in relief. W h en the bite m ec ha ni sm has been th or o u g h ly assessed a n d the cause o f the dys function pin po inted , the pa tie nt is suppli ed with a definitive plastic splint which fits over the m ola rs to b ala n ce the bite m echanism . This splint is m ade by the dentist. M r Mit chell’s in vestigatio ns are o n g o i n g a n d results available to da te s h o w that B.K. testing a n d careful assessment of the bite m ech an ism c oul d a d d a new di me nsi on to the p h y s i o t h e r a p i s t ’s m a n a g e m e n t o f a wide range o f t ro u b le so m e con dit io ns. M E A S U R E M E N T O F PAIN (Mr C. Liggins) M r Liggins re p o rt e d o n e va l u a t i o n o f the use o f 3 subjective p a in - r a ti n g scales in 50 Afri can subjects. Some o f . t h e findings are r e p o rt e d elsewhere in this issue. ' T H E R O L E S O F P H Y S I O T H E R A P Y IN T H E M A N A G E M E N T O F F R A C T U R E S O F T H E S H A F T O F FE M U R (Mrs L. Gumede) Mrs G u m e d e is to u n d e r ta k e a stu dy of the role of ph ys io th era py in the m a n a g e m e n t o f fractures o f t h e s h a f t of femur. T h e p r o p o s a l for this st u d y was pr es en te d in the following s u m m a ri s e d form: T h e r e h ab ili ta ti o n o f a patient who has sus tai ned a fr act ur e o f the shaft o f f e m ur is a long d ra w n - o u t proc ess a n d several q ue st io n s have been po se d on this issue: • Why does re h ab i li t at i o n t ak e so long? • H o w can this lengthy pe rio d o f r e h ab ili ta ti on be short en ed? • Is e n o u g h time alloc ate d to r e h ab ili ta ti on at given t r ea tm e nt sessions? • H o w m uch is be ing d o n e by the p a tie n t o n his own? • Is the pa tie nt well e n o u g h e q u ip p e d for self-therapy? • Is the pa ti e n t willing t o d o an y work? If not, wha t are his p ro b lem s? C a n the th er a pi st help to solve these pro bl em s? I f so, how? As it is no t possible to p ro vi de an swers to all the abo ve questions, it is a p p a r e n t th a t there is a need tt> re-evaluate the c on ve n ti on al a p p r o a c h to re ha b i li t at i o n o f the pati en t with fracture o f the shaft o f the femur. T h e hyp othesis to be tested is t h a t c o m p r e h e n s i v e p a t i e n t e d u c a t i o n , i m p r o v e d m o ti v a ti o n a n d psyc hological s u p p o r t i m p r o ve pati en t c o m pl ia nc e a n d t h us facilitate the overall re ha b ili ta ti o n o f a pati en t w h o has su sta in ed a f rac tu re o f t h e s h a f t o f the femur. I The aim s o f the stu dy are: 1. T o assess the i m p o r t a n c e o f fa ct o r s such as: 1.1 e d u ca tio n o f the pa tie n ts r e g ar d in g th eir co nd iti on , e x p la n a t i o n o f r e h ab ili ta ti o n pro c ed ur e s a n d th eir effects. 1.2 psychological s u p p o r t of pa tie n ts by the ph y si o ­ th erapist. 1.3 m o ti v a ti o n o f patients. 2. T o assess pati en t co m p l i an c e with respect to re hab ili ta ­ tion p r o g r am m es . 3. T o e v alu ate the effectiveness of the p h y si o t h er a p eu t i c pr o c cd u res. Pa tie n ts w ho have su s ta i n ed a fr ac tu r e o f the shaft o f the fem ur will be a llo cat ed to tw o gr ou p s in r a n d o m fashion. The first g r o u p will be tr ea te d a lo n g co n v en ti o n al lines, whilst the se co nd g r o u p will be co unselled in a dd iti on t o ha vin g the c on v en ti on al tr ea tm e n t. T hi s latter g r o u p will be given i n f o r m a t io n on their c o nd iti on ; a lso an insight into the ra ti o n al e of the d o c to r ' s t r e a tm e n t as well as the p h y s i o t h e r a p i s t ’s tr ea tm e nt . A h a n d o u t has been c om pi led to help e d u cat e the patient in all asp ect s o f his c o n d it i o n . It will give in f o r m a t io n on the whole series of events t h r o u g h o u t the lime the patient is u nd e r tr ea tm e n t. T h e h a n d o u t is seen as a mea ns o f re­ info rcing the in f o r m a t io n given to the patient verbally. LASE R A C U P U N C T U R E ( M r D. Dha nraj and M r C. Liggins) M r Liggins, w h o has been w o r k in g in association with M r D h a n r a j , re po rte d on the early impressions gain ed as a result o f the use of laser a c u p u n c t u r e in a range o f painful con di ti o ns . This m ode o f t r e a tm e n t is relatively new in D u r b a n a n d at present is being used by tw o private pr act itione rs . A c u p u n c t u r e is a well-established a n d integral part o f Oriental medicine. It is used to p ro du c e analgesia a n d a nae sth es ia, a n d in the t r e a tm e n t o f a wide ra ng e o f o r g a ni c disor de rs. It is b e c o m i n g an increasingly p o p u l a r form of alte rna tiv e th e r a p y in W es te r n medicine. This is p ro b a b ly because m o d e r n pa in research is s he d d in g new light on how a c u p u n c t u r e p r o d u c e s its effects. C u rr e nt ly , th eories of a c u p u n c tu r e analg es ia are re lated to the G a t e C o n t r o l T h e o r y a n d the est abl is he d fact th at the b o d y pro duc es e n d o g e n o u s opi ate -like subs tanc es . T h e legality o f the use o f needle a c u p u n c tu r e by p h y s io th er a p is ts in this c o u n tr y is yet to be clarified. H ow ev er , as laser a c u p u n c t u r e is a sti m u l a ti o n tech ni qu e, it falls well into the sc ope o f ph ys io th er a p y. C o nv e n ti o n a l needle a c u p u n c tu r e m ay be a c c o m p a n i e d by d is c o m f o r t a n d anxiety on insertion of the needles. Also, the a cu p u n c tu r i st must ta k e p r e ca u ti o n s to en su re sterility o f the needles. Laser a c u p u n c t u r e is totally painless a n d , be ing no n-invasive, there are n o p r o b l em s r e ga r d in g sterility. L as er (Light A m pl if i c a t io n by S t i m ul a te d E mi ss ion o f R a d ia t io n ) is a lre ad y well est abl ish ed in medicine, but the laser used for a c u p u n c t u r e is qui te different to the surgical laser in th at its intensity is so low that the tissues c a n n o t be d a m a g e d . T he a p p a r a t u s used is a single q u a r tz fibre laser with a p o w e r o f 2 mw which is e m it te d in the red pa r t o f the s p e c tr u m (A 0,632, (jm). T h is allows for m a x i m u m tissue p e n e t r a t i o n (3-15 mm). T h e frequency range can be varied be tween 0,2 Hz a n d 5 k H z a n d pulse d u r a ti o n s o f between 1 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 46 Fisioterapie, Ju n ie 1982, deel 38, nr 2 a nd 60 seconds can be selected. Ir r a d i a ti o n is app lie d to the tissues by a h a n d - h e l d stylus with a be am exit o f l mm. A p p li ca tio n is to c on v en ti on al a c u p u n c tu r e poin ts, “ trigg er ” points or t e n d e r “ n o d u l e s ” . Cl ai m s have been m a d e for the use o f l a s e r a c u p u n c t u r e in a wide ra ng e o f clinical c on d iti on s, such as de r m a to l o g y (acne vulgaris, herpes a n d ulcers), E.N.T. (sinusitis), mu sc ulo-skeletal pain sy nd ro m e s, c hr o n ic re spi ratory c o n di ti o ns ( a s t h m a ) a n d r h e um a to lo gy . W he n he initially sta rte d using laser sti m u la tio n for painful con d iti on s, M r D h a n r a j was parti cul ar ly impressed with the degree o f pain relief o b t a i n e d a nd the rate at which this was achieved. Of te n co mplete pain relief was o b t ai ne d in one tr ea tm e n t a fte r a relatively short period o f sti mulation. As a result o f these early impre ss ion s it was de cided to c o m p a r e laser a c u p u n c t u r e with o th er , m or e con v en ti on al, modal iti es su c h as u l tr a s o u n d , s h or t- w a v e a n d microwave di at h e rm y. F o u r t e e n patie nts with pain aris ing fro m a range o f muscu lo- sk ele ta l c o nd iti on s as d ia gn o s ed by do c to rs were ra n d o m l y di vid ed into 2 gr oup s, A a n d B. G r o u p A patients were tr eat ed by laser sti m ul a tio n app lie d to ac u p u n c tu re po in ts, trigger p oi nt s o r painful “ s p o t s ” . T h e pe rio d o f st i m u l a ti o n to each area being 20-25 sec onds a n d the total t r e a tm e n t pe rio d was 5-6 minute s. G r o u p B patie nts were t re a te d with u l tr a s o u n d , sh or t- w a v e or micr owa ve, applied singly o r in c o m b i n a ti o n s , for e xa m p le u l t r a s o u n d a n d s h o r t ­ wave di at h e rm y , fo r the usual t r e a tm e n t periods. A numerical ra ti n g scale was used to m ea su re initial pain evels a n d su b s eq u e n t pain relief. Results were r eco rd ed for the first tr e a tm e n t session only. Pa tients in g r o u p A sh ow ed a g reater aver ag e re d u ct io n in pain levels (68,57%) than those in g r o u p B (47,57%). In a dd it i o n 2 pa tie n ts in the fo rm er gr o u p r e po rt e d c o m pl e te re mission o f pa in after only a few m in ut e s of t r e a tm e n t a n d no pa tie nt in this g r o u p ha d less th an 50 pe r cent re d u ct io n in pa in level. It sh o u l d be e m p h a si se d th at this s ho r t re po rt is o f early impr ess ion s ga in e d f ro m the use o f laser a c u p u n c tu r e in painful con d iti on s. It is inte n de d to stud y its use f ur th er by c o n d u c t i n g a trial c o m p a r i n g its effect with th os e ob ta in e d fro m ot her , m or e c o n v e nt io na l, m e t h o d s o f p h y sio th e ra p y . A g r e at er n u m b e r o f subjects will be used a n d the trial will be c on fin e d to specific p ain syn dr o m es . E L E C T R O M Y O G R A P H Y (E .M .G .) B IO F E E D B A C K IN T H E R E H A B IL IT A T IO N O F T H E U P P E R I^IMB IN S T R O K E PA T IE N T S (M iss A. R ajkoom ar) T h e follow ing is a s u m m a r y o f the pro jec t on E .M .G . b io fe e db ac k t o be u n d e r t a k e n by Miss R a jk o o m a r. Biofeed bac k is the n a m e given to a set o f tech ni que s used in the in vestigation o f le a rn ed self-control o f physiological activity. T h is aw ar e n e ss o f the internal state o f the bo d y is b r o u g h t a b o u t by a u d i t o r y a n d / o r visual signals di splayed to the pati en t which he can m a n i p u l a t e to reach set goals. This tec hni que inserts a p a t i e n t ’s v olitio n into the gap o f an o pe n f e ed ba ck loop - hence the n a m e “ bi o f e e d b a c k ” . A l t h o u g h the use o f these techn iq ues is relatively new, the basic principles hav e been k n o w n for so m e time. T h e y reflect the fact th at fe edb ack o f in f o r m a t io n or k n o w l e d g e o f results is essential for the efficient l ea rni ng o f an y skill. This project entails the use o f clinical E .M .G . bi of eed bac k a p p a r a t u s for the t r e a t m e n t o f the u p p e r limb o f st ro ke patie nts in a n ex pe ri m e n ta l g r ou p . Muscle activity will be di sp lay ed t o the pati en t by m ea n s o f visual cues (e le ct r o m y o g r ap h s ) a n d a u d it o ry signals (increase in volu me intensity as a g r e a t e r n u m b e r o f m o t o r units a r e recruited). A c o n tr o l g r o u p will receive st a n d a r d i s e d ph y si o t h e r a p y in a cc o r d a n c e with a set p ro to co l. T h e ex pe ri m e nt al g r o u p will also receive st a n d a r d i s e d p h y si ot he r a p y , b u t E .M .G . b io fe e d ba c k will be used as an ad ju n c t in this g r ou p . The h y po th es is to be tested is: th at E .M .G . b io fee d ba ck is a useful a dj u n c t in the re h ab i li t at i o n o f the u p p e r limb f un c tio n in st ro k e patients. Since the early I 9 6 0 ’s E .M .G . b io fe e db ac k techniques have been used by ph y sio th era p is ts , parti cul ar ly in the m a n a g e m e n t o f n e u r o m u s c u l a r di sorders. A d e q u a t e work has been c arr ied o u t on the aspect o f d r o p foot in stroke pati en ts a n d the tec hn iq u es have been fo u n d to be effective in facilitating recovery. How eve r, very little a tt e n ti o n has been given to the u p p e r limb. Hence there is a need to stu dy and assess the efficacy o f E .M .G . bio fe e d b ac k in the m a n a g e m e n t o f the u p p e r limb in st r o k e patients. T h e hi story o f the m a n a g e m e n t o f st ro k e p ati en ts has s h o w n that the u p p e r limb is most resistant t o th er a p y a n d in m an y cases h a n d f un c tio n is impossible t o restore. Shou ld E . M . G . b io fe e db ac k pr ov e to be effective it will be a valuable a d d it i o n to the m e t h o d s a lre ad y used in the t r e a tm e n t o f the u p p e r limb in s t r o k e patients. P R E D IC T IO N N O M O G R A M O F N O R M A L IND IAN M A L E AND F E M A L E A D U L TS (M r A. Khan) M r K h a n has c o m m e n c e d a st ud y with the full title: Pre d ict io n N o m o g r a m o f N o r m a l Indian Ma le a n d Female Ad ul ts, Re la tin g Age a n d Height to F o r c e d Expir at ory Vo lu m e (F. E.V. ) a n d F o r c e d Vital C a p a c it y (F.V.C.). R o u t in e v i ta lo gr am s on a p p a r e n tl y n o r m al In d i a n s show th at they ha v e lower ex p ir a to r y values th an th ose indicated by p r ed ict io n n o m o g r a m s . A c o m m o n l y used n o m o g r a m is b as ed on values o b t a i n e d fro m N o r t h A m e r ic an Ca ucasians. D u r i n g trials in volving n o r m a l adults, In d i a n s present with lower e xp ir a to r y values t han expected. T hi s is not a true in d ic a tio n o f their lung f un cti on , as o b t a i n e d values are not being c o m p a r e d t o a n o m o g r a m specific to Indians. F u r t h e r m o r e , in I n di an patie nts the difference between the o b t a i n e d values a n d those o f the abo ve m en ti on ed n o m o g r a m is no t a tr ue in dic ati on of their co n di ti o n. Hence there is a need for a pr ed icti on n o m o g r a m o f respi rat or y f u n c tio n specific t o the needs o f the So u t h Afri can Indian. T he f u nc tio n o f the lung is influenced by age, sex a n d body size. F o r people o f C a u c a s i a n descent there does not a p p e a r to be a n y significant v a r ia ti o n in lung fun ctio n, whichever p a r t o f the wo rl d they live in. In general, C a u c a si a n s ten d tof have g r e a t e r vital capacities th an o t h e r ethnic groups. I n h a b i t a n t s o f the I n d i a n su b - c o n t in e n t a n d the people o f Po ly ne sia n stoc k hav e the smallest vol umes. N e g r o i d an d M o n g o l o i d people a p p e a r to oc cu py a n in ter m edi ate position. T h e difference in vital c ap aci ty has been att r i b u te d t o the v a r ia tio ns in chest size. F o r exam pl e, stud ies on Z a m b i a n Ne gr oi ds have sh o w n th em to have sm a lle r overall chest d i m e n si o n s to th ose o f C aucasians. Briefly, the p r o c e d u r e o f this stu dy is as follows: • N o r m a l In d ian male a n d female subjects in the age range 15-65 years are b e in g selected for p a r ti c i p a ti o n in the study. • E ach subject is r e qu ir e d to co m p le te a q u e st io n n a i r e de signed t o o b t a i n in f o r m a t io n o f a n y c a r d i o - r e s p i r a t o r y p r o b l e m s they m ay have. If p r o b l e m s are present, these subjects are eli m in a te d fro m the study. • A n t h r o p o m e t r i c m e a su r e m e n t s incl udi ng height, weight a n d chest size are o b t ai n e d. • E ac h subject is re qu ire d to p e r fo r m lung fu n c ti o n tests u si ng a V it alo gr aph . T h e d a t a which is being collected will be used to either d r a w up a n o m o g r a m specific to S o u t h African Indi ans , o r regression e q u a t i o n s will be o b t a i n e d so t h a t existing n o m o g r a m s can be adjusted. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )