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Background and Objectives: It has been seen that jaw opening is associated with neck extension and jaw closing is associated with neck flexion. This natural association between the jaw and neck can be used as a novel approach to treat chronic non-specific neck pain, although the effects of this concept have never been previously evaluated as a treatment strategy. This article intends to study the effects of integrating jaw opening and closing movements along with active neck exercises versus active neck exercises alone in the management of chronic non-specific neck pain.

Materials and Methods: A total of 80 patients, aged 20 to 50, with chronic non-specific neck pain were included in a double-blind randomized controlled trial, conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan from 2018 to 2022. The patients were divided into two groups: Group A patients were assigned jaw movements with active neck exercises, while Group B patients were assigned only active neck exercises. Both groups were assigned isometric strengthening exercises and self-resisted strengthening exercises for cervical spine muscles as a home plan. The study used various outcome measures, including the numerical pain rating scale (NPRS), neck disability index (NDI), neck flexion endurance (NFE), neck extension endurance (NEE), the neck proprioception error (NPE): neck flexion proprioception error (NFPE), neck extension proprioception error (NEPE), neck right rotation proprioception error (NRRPE), and neck left rotation proprioception error (NLRPE), with measurements taken at week 1 and week 6, respectively; the mean differences between the groups were measured using a two-way repeated ANOVA.

Results: The experimental group showed better improvements compared to the control group, NPRS (73%), NDI (57%), NFE (152%), NEE (83%), NFPE (58%), NEPE (65%), NRRPE (65%), and NLRPE (62%), with a significant difference (p < 0.05). Conclusions: Active neck extension and flexion movements combined with jaw opening and closing are more effective in reducing pain and disability, improving neck muscles endurance and normalizing neck proprioception in patients with chronic neck pain.

Background: The Dynamic Gait Index (DGI) is a useful tool that has been evaluated for its reliability in patients with vestibular disorders, elderly people and, in chronic stroke population. Present study was aimed to evaluate the intrarater and interrater reliability of the DGI to measure dynamic balance and gait performance in stroke patients with eye movement disorders. Methods: A sample of 30 stroke patients suffering from eye movement disorders were recruited. Two Physical therapists assessed the intrarater and interrater reliability of the DGI in two testing sessions three days apart. In the later session, two raters assessed the patients' performance simultaneously on the DGI. The reliability was calculated using the intra-class correlation coefficient (ICC2, 1). Standard error of measurement (SEM) and minimal detectable change (MDC₉₅) at 95% confidence interval were also calculated. A significance level was set at p-value <0.05. Results: The (ICC2, 1) for intrarater and interrater reliability of total DGI scores was 0.86 and 0.91 respectively. While (ICC2, 1) for intrarater and interrater reliability of individual items ranged from 0.73 to 0.91 to 0.73–0.93, respectively. The (SEM) and (MDC₉₅) for intrarater reliability of total DGI scores were 0.76 and 2.10, respectively. Corresponding values for interrater reliability were 0.62 and 1.71, respectively. Conclusions: The DGI is a reliable tool for evaluating the dynamic balance and gait performance in stroke patients with eye movement disorders. This tool showed good to excellent intrarater and interrater reliability of total DGI scores and moderate to good intrarater and interrater reliability of individual items of the DGI.

Objective: The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability.

Methods: It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons.

Results: There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05).

Conclusions: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy.

Purpose: Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy.

Methods: A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used.

Results: Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann-Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25.

Conclusion: Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.

Background: Repeatability and validity are important components of precision in any measurement system.

Aim: This study aimed to determine the effect of change in head and neck position and body posture on the repeatability of intraocular pressure (IOP) measurements with PT-100 noncontact tonometer and compare with Goldmann, PT-100 and Schi⊘tz tonometer readings.

Setting: Optometry clinic, Saudi Arabia.

Methods: The IOP was measured in one selected eye of 84 healthy participants (mean aged 21.9 ± 2.0 years) using PT-100 in three head and body positions, Goldmann tonometer and Schi⊘tz on two separate visits, in a randomised fashion. Central corneal thickness (CCT) was measured using an ultrasound pachymeter. The repeatability, agreement and correlations between CCT and IOP differentials were assessed.

Results: The IOP measured in three head and body positions with the PT-100 were similar and comparable to Goldmann IOPs in sessions one and two with 74% and 86% of PT-100 measurements within ±3 mmHg of the Goldmann tonometry, respectively, for sessions one and two. The Schi⊘tz tonometer-measured IOP was higher than the Goldmann IOPs (p < 0.05) with 60% and 44% of Schi⊘tz IOPs within ±3 mmHg of the Goldmann tonometer IOP in sessions one and two, respectively. The limits of repeatability and reproducibility were best with the PT-100 and worst with the Schi⊘tz tonometer. The mean CCT (552±36 µm) was negatively correlated with differences between Goldmann and both PT-100 and Schi0tz-measured IOP.

Conclusion: Postural changes did not affect the validity and repeatability of PT-100 readings. PT-100 measurements were interchangeable with Goldmann tonometer. Schi⊘tz overestimated Goldmann IOP in thicker corneas more than the PT-100.

BACKGROUND: Impaired vision is one of the commonest and most disabling consequence following stroke. Among all visual impairments, eye movement disorders are found in 70% of stroke patients which include nystagmus, strabismus, gaze palsies, disconjugate eye movements and cranial nerve palsies. They have a wide ranging impact on balance and activities of daily livings by creating difficulties in maintaining normal alignment and appropriate movement of eyes. The purpose of this study was to examine the effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders.

METHODS: This study is a randomized controlled trial and was conducted in the University of Lahore Teaching Hospital from May 2019 to October 2020. A sample of 64 patients was recruited and randomly allocated into experimental and control group. 32 patients in experimental group were treated with visual scanning exercises along with task specific approach and 32 patients in control group were treated with task specific approach alone. Pre and post assessment of balance and activities of daily livings was assessed on BERG BALANCE SCALE and BARTHEL INDEX SCALE at baseline and at 4th week.

RESULTS: Intra-group analysis of BERG BALANCE SCALE in experimental group showed statistically significant result (p < 0.05) in all items except in items 4, 13 and 14 respectively. Intra-group analysis of BERG BALANCE SCALE in control group showed statistically significant result (p < 0.05) in items 3, 5, 8 and 12 respectively, whereas remaining all items showed statistically insignificant result. Intra-group analysis of BARTHEL INDEX SCALE in experimental group showed statistically significant result in all items (p < 0.05) except in items 9 and 10 respectively. Intra-group analysis of BARTHEL INDEX in control group showed statistically significant result (p < 0.05) in items 1, 3, 4 and 8 respectively whereas remaining all items showed statistically insignificant result. Inter-group analysis showed statistically significant result in total scores of BERG BALANCE SCALE (p = 0.000) and BARTHEL INEX SCALE (p = 0.033).

CONCLUSION: Visual scanning exercises along with task specific approach were found to be more effective in comparison to task specific approach alone.

TRIAL REGISTRATION: Trial registration number: [IRCT20190717044237N1], trial registration date: 10/11/2019.

Background: Assessment of cervical active range of motion (CAROM) in three planes was one of the primary outcome measures used by the clinicians.

Methodology: We enrolled 30 patients (14 males and 16 females) with chronic neck pain and respiratory dysfunction fulfilling inclusion criteria. Two trials of CAROM measurement for flexion, extension, left and right lateral flexion and left and right rotation were performed, with a gap of one week to measure test retest reliability of CROM device. Intraclass correlation coefficient (ICC), standard errors of measurement (SEM) and minimal detectable change (MDC) were calculated to test the intrarater reliability.

Results: Intrarater reliability of repeated measurements of CAROM using the CROM device was found to be good. The ICC values ranged between 0.88-0.97 for flexion, 0.93-0.98 for extension, 0.92-0.98 for right lateral flexion,0.93-0.98 for left lateral flexion. For right rotation it was 0.88-0.97, for left lateral rotation it was 0.95-0.99. The standard error of measurement for these movements ranged from 1.5° to 2.9°. Minimal detectable change ranged from 3.5°for extension to 6.8°for left lateral flexion.

Conclusion: Cervical range of motion device is a reliable tool for measuring cervical active range of motion in patients simultaneously suffering from chronic neck pain and respiratory dysfunction.

The current study was carried out with the aim of investigating the effect of maximally relaxed lying posture on disfluencies in young adults who stutter. A total of 24 participants (17 males, seven females; mean age = 24.9 ± 6.2 years) with developmental stuttering were a part of the study. The participants were asked to perform spontaneous speaking and reading aloud tasks in standard sitting and maximally relaxed lying postures. The severity of stuttering for the studied postures was estimated by using the Stuttering Severity Instrument. The results on the Stuttering Severity Instrument showed that stuttering parameters improved during the maximally relaxed lying posture compared with the standard sitting position. The results are discussed in the light of motor control concepts. It is concluded that the maximally relaxed lying posture can facilitate improvement in stuttering scores during spontaneous speaking as well as reading aloud in young adults who stutter. Reduced stuttering scores in the maximally relaxed lying posture suggest that speech therapists can position participants in this position while treating people who stutter.

Background: Jaw and neck systems have been shown to be functionally related and changes in either system can modulate gross motor functions, such as posture control. It remains to be seen if any change in jaw position can affect fine motor skills. The objective of this study was to determine the effect of resting, open and clenched jaw positions on various handwriting parameters while standing on firm and unstable surfaces.

Methods: Handwriting samples were collected from 36 healthy male participants (age, 15-35 years) using a digitizer tablet (WACOM Intuos 4) with noninking pen in the resting, open and clenched jaw positions while standing on firm and unstable surfaces. The measured handwriting parameters included duration, vertical size, horizontal size, absolute size, average absolute velocity, and absolute jerk. Recordings and analyses were performed using NeuroScript MovAlyzeR software.

Results: All handwriting parameters varied among the resting, open, and clenched jaw positions on both the firm and unstable surfaces. However, based on statistical analyses, there were no significant differences in the handwriting parameters among three jaw positions on both surfaces (p > .05).

Conclusion: This study revealed that all handwriting parameters varied among the resting, open, and clenched jaw positions on both the firm and unstable surfaces, showing that change in the jaw motor system may potentially affect the fine motor skills. However, on statistical analysis, there was no significant effect of 3 studied jaw positions on fine motor skills as seen on gross motor skills among healthy individuals.

Background: Health professionals, including physical therapists (PTs), are known to migrate for better jobs, as well as for personal and professional development. However, this involves risks of maladjustment, discrimination, and exploitation. We conducted this study to investigate the experiences of overseas trained PTs in Saudi Arabia (SA) and their perceptions about physical therapy practice and problems regarding the profession in the country.

Methods: A questionnaire and accompanying explanation of the study was sent to 175 members of the Saudi Physical Therapy Association (SPTA) working in SA who had been trained outside SA and had a minimum of one year of work experience before moving to SA.

Results: One hundred and fifty (86%) respondents completed the questionnaire. Among the respondents, the majority had more than five years of work experience after moving to SA. While 54% of the respondents reported that they were satisfied with their work experiences in SA, the remaining respondents reported their dissatisfaction for various reasons.

Conclusions: With the increase in aged population and rise in disability, the need for PTs has simultaneously increased in the health care sector around the world, including in SA. Until PTs of local origin are ready to fill the requirements, the services of PTs from other countries will be required in SA. Although the majority of respondents reported having positive work experiences in SA, the negative aspects and challenges faced by PTs in SA have also been highlighted in this study. These problems need to be addressed in order to promote the development of a better and more holistic approach to patient care.